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Comparison of early and late surgical intervention for lumbar disc herniation: is earlier better?

Research paper by Ryuichiro R Akagi, Yasuchika Y Aoki, Yoshikazu Y Ikeda, Fumitake F Nakajima, Seiji S Ohtori, Kazuhisa K Takahashi, Masatsune M Yamagata

Indexed on: 19 Jun '10Published on: 19 Jun '10Published in: Journal of Orthopaedic Science



Abstract

The optimal timing for surgical intervention in cases of lumbar disc herniation is debatable. This retrospective study sought to determine whether early surgical intervention resulted in greater improvement in clinical outcomes.A total of 46 patients with lumbar disc herniation treated by microendoscopic discectomy were reviewed. Surgery was performed when leg pain persisted despite adequate conservative treatment. The patients were divided into two groups according to the duration of symptoms before surgery, the early group being symptomatic for <or=3 months and the late group for >3 months. Surgical time, blood loss, severity of back pain, leg pain and numbness (visual analogue scale, or VAS), and a patient-oriented evaluation score (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, or JOABPEQ) before and after surgery were compared. The JOABPEQ is a new evaluation method for lumbar spinal disorders based on Roland-Morris disability questionnaires and Short Form 36.There were 23 patients in each group. No significant differences were found between the groups in patients' demographics (age, sex, type of herniation), surgical time, blood loss, or pre- and postoperative VAS (lower-back pain, leg pain, numbness). There were no significant differences between the groups in the scores for the five subscales - pain-related disorders, gait disturbance, lumbar spine dysfunction, social life disturbance, psychological disorders - of the preoperative JOABPEQ. Postoperative scores for psychological disorders improved significantly (P < 0.05) in the late group (mean score 39.9) compared to the early group (mean score 22.1). Interestingly, no significant difference of improvement in the scores other than psychological disorder was found between the two groups.Early surgical intervention did not result in greater improvement of clinical outcomes for patients with lumbar disc herniation. Later surgical intervention resulted in significant improvement of psychological disorders.