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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A retrospective cohort study.


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.


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.


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.


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


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.


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.


Level of Evidence:3

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