Immediate Versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits

Petr, Ondra; Glodny, Bernhard; Brawanski, Konstantin; Kerschbaumer, Johannes; Freyschlag, Christian F.; Pinggera, Daniel; Rehwald, Rafael; Hartmann, Sébastian; Ortler, Martin; Thomé, Claudius

doi:10.1097/brs.0000000000002295

Cited by 26 publications

(15 citation statements)

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“…Differently, the improvement of preoperative motor deficits depends on various factors like the duration of symptoms and on BMI [26]: the obese patient group in our cohort experienced symptoms for a shorter period but needed the same amount of time to recover from motor deficits as non-obese patients. Therefore, the overall factor of time and its impact on short-term recovery may be neglected for young patients presenting with obesity.…”

Section: Discussionmentioning

confidence: 75%

The impact of obesity and smoking on young individuals suffering from lumbar disc herniation: a retrospective analysis of 97 cases

et al. 2019

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The negative impact on spinal diseases may apply not only to obesity but also to smoking. To investigate the influence of obesity and smoking on the development and recovery of lumbar disc herniation in young adults. Retrospective analysis of 97 patients who presented with lumbar disc herniation at the authors' department between 2010 and 2017. Data were collected using the patients' digital health records including demographics, clinical and neurological characteristics, treatment details, and outcomes. Ninety-seven patients between 17 and 25 years were included in this retrospective analysis. Patients were categorized into two groups according to their body mass index: obese (O, ≥ 30 kg/m 2 ) and non-obese (NO, < 30 kg/m 2 ). The proportion of obese patients in our cohort vs. in the overall population differed significantly (19.4% vs. 3.8-7.1%, RR 3.17; p < 0.01). Group NO showed a trend toward faster recovery of motor deficits (p = 0.067) and pain (p = 0.074). Also, the proportion of regular smokers differed significantly from the numbers of known smokers of the same age (62.4% vs. 30.2%, RR 2.0; p = 0.01). Obesity plus smoking showed a significantly negative impact on motor deficits postoperatively (p = 0.015) and at discharge (p = 0.025), as well as on pain values (p = 0.037) and on analgesic consumption (p = 0.034) at 6 weeks follow-up. The negative impact of obesity and smoking on the occurrence of lumbar disc herniation could be demonstrated for individuals aged 25 or younger. Furthermore, a trend to earlier recovery of motor deficits and significantly lower pain scales for non-obese and non-smoking patients could be shown.

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Section: Discussionmentioning

confidence: 75%

The impact of obesity and smoking on young individuals suffering from lumbar disc herniation: a retrospective analysis of 97 cases

et al. 2019

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“…Sicher scheint, dass die operative Therapie (in einem Kollektiv mit 40 % Paresen) der konservativen Therapie überlegen ist [28], eine Vermeidung langer Symptomatik (Tage bis Monate) scheint weitere Vorteile [29] hinsichtlich der funktionellen Wiederherstellung zu bieten. Eine aktuelle retrospektiv vergleichende Studie, die vor allem schwere motorische Defizite einschloss, konnte einen Vorteil der frühzeitigen Nukleotomie (< 48 h) nachweisen [30] (LoE 2b).…”

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Scientific Backgrounds for the Timing of Acute Care Surgery

et al. 2019

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The correct timing of urgent surgery in the field of orthopedic and trauma surgery is under constant discussion. The authors of this review like to present a scientific based recommendation for the timing of acute care surgery using the TACS-classification for the description of urgency. The timing and priority of the indicated procedure is deduced only from the expected mortality and disability caused by a potential delay. A proposal for a nomenclature is given to be integrated in the clinical practice and to be completed.

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“…13 Several studies have been conducted for the ideal timing in lumbar discectomy, however without consensus in their results. 6,[13][14][15][16] Generally, a minimum waiting time of 6 to 8 weeks has been established due to the high probability of spontaneous symptom resolution. 7,8,13 However, it is still unclear whether a longer time to surgery (TTS) also leads to worse outcomes, and -if so -whether there is an optimal maximum TTS for favorable patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…2,15,16 However, the reports often evaluate pre hoc defined TTS cutoffs, or do not take into account long-term patientreported outcome, or are based on retrospective data. 2,13,[15][16][17][18][19] A recent analysis indicated that delayed surgery is associated with a lower probability of improvement in leg pain at 1 year postoperatively and that a TTS cutoff of 24 weeks should be aimed for to maximize chances of symptomatic improvement. 18 However, this study focused solely on leg pain outcome.…”

Section: Introductionmentioning

confidence: 99%

“…In fact, little is known on the influence of TTS on patient-reported functional impairment outcomes after elective discectomy. 15 Therefore, the aim of this study was to evaluate the impact of TTS on functional outcome after lumbar discectomy, as well as to evaluate different thresholds to determine the optimal maximum TTS, up to which the most favorable surgical results can be obtained.…”

Section: Introductionmentioning

confidence: 99%

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Timing of Surgery in Tubular Microdiscectomy for Lumbar Disc Herniation and Its Effect on Functional Impairment Outcomes

et al. 2020

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Objective: While it has been established that surgery for lumbar disc herniation, excluding emergent indications, should only be performed after weeks of conservative treatment, it has also been established that late surgery is associated with poorer outscomes in terms of leg pain. However, nothing is known concerning the timinig and functional outcome. We quantify the association of time to surgery (TTS) with functional impairment outcome and identify a maximum TTS cutoff. Methods: A consecutive series of patients who underwent tubular microdiscectomy for lumbar disc herniation was included. A reduction of ≥ 30% in the Oswestry Disability Index from baseline to 12 months was defined as the minimum clinically important difference (MCID). TTS was defined as time of symptom onset to surgery in weeks. The maximum TTS cutoffs were derived both quantitatively by an area under the curve (AUC) analysis, as well as qualitatively based on cutoff-specific MCID rates. Results: Inclusion was met by 372 patients, among which 327 (87.9%) achieved MCID. MCID achievement was associated with lower TTS (hazard ratio, 0.725; 95% confidence interval, 0.557-0.944; p = 0.014). The optimum maximum TTS based on AUC was 21.5 weeks. The qualitative analysis showed a continuous drop of MCID rates with increasing TTS, with values > 80% until week 14. Conclusion: Our findings suggest that longer TTS is associated with a poorer patient-reported outcome in terms of functional impairment, and that-depending on the calculation method and according to the literature-a maximum TTS of between 14 to 22 weeks should likely be aimed for.

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Immediate Versus Delayed Surgical Treatment of Lumbar Disc Herniation for Acute Motor Deficits

Abstract: 3.

Cited by 26 publications

References 27 publications

The impact of obesity and smoking on young individuals suffering from lumbar disc herniation: a retrospective analysis of 97 cases

The impact of obesity and smoking on young individuals suffering from lumbar disc herniation: a retrospective analysis of 97 cases

Scientific Backgrounds for the Timing of Acute Care Surgery

Timing of Surgery in Tubular Microdiscectomy for Lumbar Disc Herniation and Its Effect on Functional Impairment Outcomes

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