Who Are You Taking to the PROM? Discrepancies Between Patient-Reported Outcomes and Clinical Evaluation in a FELD Cohort

Background: Full Endoscopic Lumbar Discectomy (FELD) is one of the latest surgical techniques developed for discectomy in the lumbar spine. It is considered a truly minimally invasive procedure with results at least equal to previous techniques regarding decreasing disability and improving quality of life with an acceptable rate of complications [1, 2]. Methods: This study is a retrospective cohort study on patients who underwent a FELD procedure with patient-reported outcome measures (PROMS) and clinical findings. Of 147 patients who had a FELD procedure between 2013 and 2018, 86 answered the follow-up SweSpine PROMs, Oswestry Disability Index (ODI), and EQ5D and EQ5D VAS and were enrolled in this study. FELD patients attended a clinical examination after a mean time of 4.3 years and answered a specific questionnaire. The clinical examination included Lasegue’s test, calf muscle hypotrophy, and muscle weakness in 52 patients who attended the examination. Results: An improvement was found in ODI (from 43.5 to 14.8) and EQ-VAS (48 to 73.7). Despite the high incidence of numbness (60%) and weakness (52%), patients graded their overall satisfaction with the surgery at a mean rate of 7.55 (SD=2.8) on a 0-10 scale. 80 % of the patients would recommend FELD surgery. 83% percent of the patients reported being pain-free regarding Low Back Pain (LBP) and 87% for leg pain at the follow-up. However, a change in work assignments due to back-related problems occurred in 45% of cases. Provokable pain, defined as the ability to elicit back or leg pain through heavy lifting, static standing, running, etc, was described by 65% and 53.3% respectively. Conclusion: The main findings of this study are that patients who underwent FELD reported a high overall satisfaction rate of 7.55 on a scale of 10 and a significant improvement in PROMs despite high rates of numbness and hyperalgesia.