Aim To evaluate the influence of preoperative symptoms duration on surgical outcome of one-level lumbar disc herniation surgery. Methods In a prospective randomized study, 67 adult patients with one-level lumbar disc herniation were analysed. The patients whose duration of symptoms was <6 months were included in the case group, while those with the duration of symptoms ˃6 months formed the control group. The investigated preoperative variables were: pain intensity in the back and legs (Visual Analogue Scale - VAS), Sciatica Bothersomeness Index (SBI), index of disability (Oswestry Disability Index - ODI). Postoperative variables were: pain intensity in the back and legs (VAS), SBI, ODI, and outcome according to the Odom’s criteria (excellent, good, satisfactory and poor). Significance level was set at p <0.05. Results A statistically significant difference was recorded between the groups, showing a better decrease of radicular pain intensity and sciatica bothersome, as well as patients disability in the case group (p<0.001). According to the Odom’s criteria the outcome was better in the case group, since the difference between the groups was statistically significant too (p<0.05). Conclusion Early lumbar disc herniation surgery performed within the first 6 months from the start of symptoms is beneficial due to decreases of radicular pain intensity, sciatica bothersomeness, and patient’s disability.
Fisher C, Noonan V, Bishop P, Boyd M, Fairholm D, Wing P, et al. Outcome evaluation of the operative management of lumbar disc herniation causing sciatica. J Neurosurg 2004:317–24.
2
Weber H, Holme I, Amlie E. The natural course of acute sciatica with nerve root symptoms in a doubleblind placebo-controlled trial evaluating the effect of piroxicam. Spine 1993:1433–8.
3
Hofstee D, Gijtenbeek J, Hoogland P, Van Houwelingen H, Kloet A, Lotters F, et al. Westeinde Sciatica Trial: randomized controlled study of bedrest and physiotherapy for acute sciatica. J Neurosurg 2002;(Suppl 1):45–9.
4
Rihn J, Hilibrand A, Radcliff K, Kurd M, Lurie J, Blood E, et al. Duration of symptoms resulting from lumbar disc herniation: Effect on treatment outcomes: Analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am 2011:1906–14.
5
Gerbershagen K, Gerbershagen H, Lindena G, Lachenmayer L, Lefering R, Schmidt C, et al. Prevalence and impact of pain in neurological inpatients of a German teaching hospital. Clini Neurol Neurosurg 2008:710–7.
6
Omidi-Kashani F, Hasankhani G, Kachooei E, Rahimi A, Khanzadeh M, R. Does duration of preoperative sciatica impact surgical outcomes in patients with lumbar disc herniation. Neurol Res Int 2014:565189.
7
Silverplats K, Lind B, Zoëga B, Halldin K, Gellerstedt M, Brisby H, et al. Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up. Eur Spine J 2010:1459–67.
8
Rothoerl R, Woertgen C, Brawanski A. When should conservative treatment for lumbar disc herniation be ceased and surgery considered? Neurosurg Rev 2002:162–5.
9
Blazhevski B, Filipche V, Cvetanovski V, Simonovska N. Predictive value of the duration of sciatica for lumbar discectomy. Contribut Sec Biol Med Sci 2008:325–35.
10
Jönsson B. Patient-related factors predicting the outcome of decompressive surgery. Acta Orthop Scand 1993:69–70.
11
Peul W, Van Den Hout W, Brand R, Thomeer R, Koes B. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ 2008:1355–8.
12
Teles A, Khoshhal K, Falavigna A. Why and how should we measure outcomes in spine surgery? J Taibah Univ Med Sci 2016:91–7.
13
Coretti S, Ruggeri M, Mcnamee P. The minimum clinically important difference for EQ-5D index: a critical review. Expert Rev Pharmacoecon Outcomes Res 2014:221–33.
14
Lieber A, Boniello A, Kerbel Y, Petrucelli P, Kavuri V, Jakoi A, et al. Low socioeconomic status is associated with increased complication rates: are risk adjustment models necessary in cervical spine surgery. Global Spine J 2020:748–53.
15
Abdallah A, Seyithanoğlu M. Evaluation of the demografic and socioeconomic factors affecting recurrence of lumbar disc herniation: a prospective study. J Turk Spinal Surg 2019:121–6.
16
Mattei T. Statistically significant" does not necessarily mean “clinically different” on pain/quality of life scales: opportune remarks on clinical outcomes measures in cervical spondylotic myelopathy. Neurosurgery 2012:518–21.
17
Coderre T, Katz J, Vaccarino A, Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 1993:259–85.
18
Zhou F, Zhao Y, Zhu L, Jiang J, Huang M, Zhang Y, et al. Compressing the lumbar nerve root changes the frequency-associated cerebral amplitude of fluctuations in patients with low back/leg pain. Sci Rep 2019:2246.
19
Rätsep T, Abel A, Linnamägi Ü. Patient involvement in surgical treatment decisions and satisfaction with the treatment results after lumbar intervertebral discectomy. Eur Spine J 2014:873–81.
20
Pitsika M, Thomas E, Shaheen S, Sharma H. Does the duration of symptoms influence outcome in patients with sciatica undergoing micro-discectomy and decompressions. Spine J 2016;(Suppl 4):S21-25.
21
Weber H. Lumbar disc herniation. A controlled prospective study with ten years of observation. Spine 1983:131–40.
22
Alentado V, Lubelski D, Steinmetz M, Benzel E, Mroz T. Optimal duration of conservative management to surgery for cervical and lumbar radiculopathy: a literature review. Global Spine J 2014:279–86.
23
Hurme M, Alaranta H. Factors predicting the result of surgery for lumbar intervertebral disc herniation. Spine 1987:933–8.
24
Støttrup C, Andresen A, Carreon L, Andersen M. Increasing reoperation rates and inferior outcome with prolonged symptom duration in lumbar disc herniation surgery -a prospective cohort study. Spine J 2019:1463–9.
25
Dvorak J, Gauchat M, Valach L. The outcome of surgery for lumbar disc herniation: I. A 4-17 years’ follow-up with emphasis on somatic aspects. Spine 1988:1418–22.
26
Carragee E, Kim D. A prospective analysis of magnetic resonance imaging findings in patients with sciatica and lumbar disc herniation. Correlation of outcomes with disc fragment and canal morphology. Spine 1997:1650–60.
27
Siccoli A, Staartjes V, De Wispelaere M, Schröder M. Association of time to surgery with leg pain after lumbar discectomy: is delayed surgery detrimental? J Neurosurg Spine 2019:160–7.
28
Nygaard O, Kloster R, Solberg T. Duration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow up. J Neurosurg 2000;(Suppl 2):131–4.
29
Ng L, Sell P. Predictive value of the duration of sciatica for lumbar discectomy. A prospective cohort study. J Bone Joint Surg Br 2004:546–9.
30
Mixter W, Barr J. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 1934:210–5.
31
Barrios C, Ahmed M, Arrotegui J, Björnsson A. Clinical factors predicting outcome after surgery for herniated lumbar disc: an epidemiological multivariate analysis. J Spinal Disord 1990:205–9.
32
Junge A, Dvorak J, Ahrens S. Predictors of bad and good outcomes of lumbar disc surgery. A prospective clinical study with recommendations for screening to avoid bad outcomes. Spine 1976:460–8.
33
Bečulić H, Skomorac R, Jusić A, Alić F, Imamović M, Mekić-Abazović A, et al. Impact of timing on surgical outcome in patients with cauda equina syndrome caused by lumbar disc herniation. Med Glas (Zenica) 2016:136–41.
34
Moranjkić M, Ercegović Z, Hodžić M, Brkić H. Outcome prediction in Lumbar disc herniation surgery. Acta Med Sal 2010:75–80.
35
Aoki Y, Sugiura S, Nakagawa K, Nakajima A, Takahashi H, Ohtori S, et al. Evaluation of nonspecific low back pain using a new detailed visual analogue scale for patients in motion, standing, and sitting: characterizing nonspecific low back pain in elderly patients. Pain Res Treat 2012:680496.
36
Grøvle L, Haugen A, Keller A, Natvig B, Brox J, Grotle M. The bothersomeness of sciatica: patients’ self-report of paresthesia, weakness and leg pain. Eur Spine J 2010:263–9.
37
Yates M, Shastri-Hurst N. The Oswestry Disability Index. Occupational Medicine 2017:241–2.
38
Broekema A, Molenberg R, Kuijlen J, Groen R, Reneman M, Soer R. The Odom’s criteria: validated at last: a clinimetric evaluation in Cervical spine surgery. Bone Joint Surg Am 2019:1301–8.
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