Increasing reoperation rates and inferior outcome with prolonged symptom duration in lumbar disc herniation surgery — a prospective cohort study

Støttrup, Christian; Andresen, Andreas; Carreon, Leah Y.; Andersen, Mikkel

doi:10.1016/j.spinee.2019.04.001

Cited by 27 publications

(45 citation statements)

References 22 publications

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“…Published studies suggest that if surgery is done within the first 3 months of leg pain, then the long-term results of such patients are better compared to those in whom surgery is delayed. 2 Only a few studies focus on the size of disc prolapse. [3][4][5] ) Massive disc prolapse is defined on magnetic resonance imaging as a condition where herniated disc material occupies 50% or more anteroposterior diameter of spinal canal.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Functional Outcomes Between Lumbar Interbody Fusion Surgery and Discectomy in Massive Lumbar Disc Herniation: A Retrospective Analysis

Gupta

Chhabra

Nagarjuna

et al. 2020

Global Spine Journal

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Study Design: Retrospective analysis. Objective: Lumbar disc herniation is one the most common condition responsible for low back and radicular pain. Although the symptoms are not proportional to the size of disc prolapse but massive disc herniation frequently needs surgical management. According to literature, the incidence of low back pain, recurrent disc herniation and segmental instability are more in discectomy whereas incidence of adjacent segment degeneration (ASD) is more after fusion surgery. There are very few studies that directly compare long-term functional outcome of both these procedures. We compared the functional outcome of both the procedures in this study. Methods: All patients of massive disc prolapse, operated at our center between 2011 to 2017, were contacted. All the patients underwent either discectomy or transforaminal lumbar interbody fusion (TLIF). Functional outcomes of all the patients were collected using visual analogue scale (VAS) (back), VAS (leg), modified Oswestry Disability Index (mODI), Sciatica Bothersomeness Index (SBI), and McNab’s criterion. Various complications were also analyzed. Results: There were 144 patients in the discectomy group and 123 patients in the TLIF group. Mean duration of follow-up was 55.07 months and 51.86 months, respectively. Both the groups show no significant difference in VAS. Significant difference was seen in mODI and SBI favoring discectomy. McNab’s criterion showed excellent result in 80% of patients of discectomy compared with 68% patients of TLIF. Overall complication rate in discectomy group was 11% whereas 13% in TLIF group. Conclusion: Both show good functional outcome but better in discectomy. Recurrent herniation and instability were noticed more with discectomy and ASD was more common after fusion surgeries. The choice of procedure should be individualized, and it also depends on surgical expertise, but in developing countries where resources are constrained, discectomy should be preferred.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Functional Outcomes Between Lumbar Interbody Fusion Surgery and Discectomy in Massive Lumbar Disc Herniation: A Retrospective Analysis

Gupta

Chhabra

Nagarjuna

et al. 2020

Global Spine Journal

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“…One of our methods of analyzing the influence of TTS resulted in an optimum TTS of 22 weeks (= 5.5 months), which may reinforce the results of Sabnis and Diwan 13 as well as Siccoli et al 18 In addition, our qualitative analysis showed a continuous decrease in MCID achievement with increasing TTS, and this finding is supported by most of the studies. 13,16,18,19,35,[38][39][40][41] For example, Støttrup et al 19 found that even surgery after 3 months leads to worsened outcomes at 1 year already. However, their analysis was focused solely on leg pain.…”

Section: Discussionmentioning

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%

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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“…Intriguingly, the duration of LBP may correlate with SIJ degradation. Previous studies reveal the prolonged duration of symptoms in patients with LDH may relate to poor prognosis and worse therapeutic outcomes (46,47). However, no research concerns the relationship between morphologic changes of SIJ and the duration of LBP in patients with LDH until now.…”

Section: E363mentioning

confidence: 99%

Lumbar Disc Herniation is a Nonnegligible Factor for the Degeneration of Sacroiliac Joints

et al. 2021

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Background: Sacroiliac joint (SIJ) abnormality is a potential source of low back pain (LBP), therefore numerous patients receive various treatments because of the degenerative changes of SIJ. However, the outcome is unfavorable for patients because these morphologic alterations are common but not the origins of LBP. Previous studies revealed lumbar fusion and transitional vertebra increased the prevalence of degeneration of SIJ. Lumbar disc herniation (LDH) is one of the most common lumbar diseases, but there is no study regarding the relationship between LDH and SIJ degradation. Objectives: The aim of this study was to investigate the severity of SIJ degeneration in patients with LBP with LDH. The relationship between degenerative changes of SIJ and LDH was also assessed. Study Design: Retrospective observational study. Setting: This study was conducted in 2 medical centers located in southeast and midwest China, respectively. Methods: Lumbar and pelvic computed tomography (CT) scans of patients with LDH (LDH group) from January 2016 to May 2020 were reviewed using a picture archiving and communication system. The control group was age, gender, and body mass index–matched patients with LBP without LDH. Patients underwent whole abdomen and pelvic CT examinations due to non-musculoskeletal disorders. Scores of SIJ degeneration were compared between patients with LDH and the control group. Differences in SIJ degeneration among patients with LDH with diverse characteristics, symptoms, and complications were also evaluated. Univariate and multivariate linear mixed model (LMM) was chosen to identify the factors associated with SIJ degeneration. Results: CT examinations of 782 patients with LDH were assessed, whereas 223 patients were in the control group. The SIJ degeneration score of the LDH group and control group were 6.00 (5.00) and 3.00 (4.00) (P < 0.05). Age and whether patients suffered from LDH were included in the LMM, which involved all reviewed patients (P < 0.05). Regarding the characteristics of LDH, the patients with more herniated discs had more severe SIJ degeneration. The score of SIJ degradation in patients with upper LDH was significantly higher than the other patients with LDH (12.00 [4.00] vs. 6.00 [4.00]; P < 0.05). Similarly, more significant SIJ degeneration was observed in patients with LDH who had secondary lumbar spinal stenosis (10.00 [4.00] vs. 5.00 [4.00]; P < 0.05). The scores of SIJ degradation were significantly greater in patients with LDH with sciatica, numbness, weakness, and/or cauda equina syndrome. Age and LDH were identified as associated factors for more serious degeneration of SIJ among patients with LDH. Limitations: The main limitation of this study was the retrospective observational nature. Hence our study described that SIJ degeneration was relevant to LDH, but the causal relationship was uncertain. Magnetic resonance imaging was not chosen in this study. Conclusions: The SIJ degeneration in patients with LDH was more serious than in individuals without LDH. SIJ degeneration was more significant in patients with LDH with more pathological alterations, symptoms, and complications. Age and LDH relate to SIJ degeneration. Therefore the diagnosis and selection of treatment for SIJ changes should comprehensively consider the coexistence of LDH. Key words: Lumbar disc herniation, low back pain, sacroiliac joint, degeneration, sciatica, numbness, weakness, cauda equina syndrome, computed tomography, linear mix model

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Increasing reoperation rates and inferior outcome with prolonged symptom duration in lumbar disc herniation surgery — a prospective cohort study

Cited by 27 publications

References 22 publications

Comparison of Functional Outcomes Between Lumbar Interbody Fusion Surgery and Discectomy in Massive Lumbar Disc Herniation: A Retrospective Analysis

Comparison of Functional Outcomes Between Lumbar Interbody Fusion Surgery and Discectomy in Massive Lumbar Disc Herniation: A Retrospective Analysis

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

Lumbar Disc Herniation is a Nonnegligible Factor for the Degeneration of Sacroiliac Joints

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