COVID-19 and Spontaneous Resolution of Lumbar Disk Prolapse: A Retrospective Cohort Study of Patients Awaiting Microdiscectomy

Abstract

Introduction: Between individual patients with lumbar disc prolapse (LDP), the natural course of disease is significantly variable. Spontaneous resolution is reported to occur in up to 70% of cases. However, we currently cannot predict for whom and when this will occur. Neurosurgical intervention is indicated for LDP patients with non-tolerable pain after at least 8-12 weeks of conservative management, or significant neurological deficit. Channelling essential resources in the National Health Service (NHS) to fight the COVID-19 pandemic led to the postponement of most elective operations, including microdiscectomy. This left many LDP patients previously considered to be surgical candidates with conservative-only options in the interim. To our knowledge, we are the first centre to report the specific impact of the peri- and post-pandemic period on waiting list times, delayed elective microdiscectomy, and the incidence of spontaneous LDP resolution. Methods: Retrospective case series of a prospectively collected electronic departmental database identified LDP patients that would have been impacted by the COVID-19 pandemic at some point in their care pathway (March 2020 - February 2022). Further information was obtained from electronic patient records. Results: 139 LDP patients were listed for elective microdiscectomy at the time of postponement of elective surgery. Over a third of LDP patients (n=47, 33.8%), in shared decision with the responsible neurosurgeon, had their re-scheduled microdiscectomy cancelled due to clinical improvement (14.1%), radiological regression (6.5%) or both (12.2%). Conclusion: Our single-centre retrospective analysis revealed that for over a third of LDP patients, the prolonged post-pandemic waiting list times for elective microdiscectomy resulted in their surgery not taking place either due to spontaneous clinical improvement or proven radiological regression. Considering this, a prolonged conservative approach to LDP may be appropriate in some patients – allowing time for natural resolution, whilst avoiding perioperative risks.