Immediate versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits: The Impact of Surgical Timing on Functional Outcome

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Abstract

STUDY DESIGN:

A retrospective cohort study.

OBJECTIVE:

The aim of the study was to assess the impact of time to surgery in patients with MDs on their functional outcome. The current single-center study presents results of emergency surgery for LDH in a group of patients with acuteparesis in a “real-world” setting.

SUMMARY OF BACKROUND DATA:

Motor deficits (MDs) are a frequent symptom of lumbar disc herniation (LDH).While surgery within 48 hours has been recommended for cauda-equina syndrome, the best timing of surgery for acute MDscontinues to be debated. The effect of early surgery has been proposed but remains to be unproven.

METHODS:

330 patients with acuteparesis due to LDH acutely referred to our department and surgically treated using microsurgical discectomy from 01/2013-12/2015 were included. Based on the duration of MD and surgical timing, all patients were classified into two categories: Group I included all patients with a paresis<48h and Group II >48h. Patient demographics, LDH/clinical/treatment characteristics, and outcomes were collected prospectively.

METHODS:

Severity of paresis (MRC 0-4), surgery-relatedcomplications, functional recovery of motor/sensory deficits, sciatica, retreatment/recurrencerates, and overall neurological outcome were analyzed.

RESULTS:

Group I showed significantly faster recovery of moderate/severe paresis (MRC 0-3) at discharge, and 6-weeks/3-months follow-up (P≤0.001), while there were no significant differences in recovery for mild paresis (MRC 4). Sensory deficits also recovered substantially faster in Group I at 6-weeks (P=0.003) and 3-months follow-up (P=0.045).BMI, preoperative MRC-grade and duration of MDs were identified as significant predictors for recovery of paresis at all follow-ups with substantial impact on patient reported outcomes including sciatica and/or dermatomal sensory deficits.

CONCLUSIONS:

Given the superior rates of neurological recovery of acutemoderate/severe MDs, immediate surgery should be the primary option. Yet, a prospective randomized clinical trial is needed to confirm the superiority of emergency surgery.

CONCLUSIONS:

Level of Evidence:3

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