Does the duration of symptoms influence outcome in patients with sciatica undergoing micro-discectomy and decompressions?
Spine J. 2016 Feb 29;
Authors: Pitsika M, Thomas E, Shaheen S, Sharma H
BACKGROUND: Early surgical treatment for back and leg pain secondary to disc herniation has been associated with very good outcomes. However, there is conflicting data on the role of surgical treatment in case of prolonged radicular symptomatology.
PURPOSE: We aimed to evaluate whether the duration of symptoms at presentation affects the subjective outcome.
STUDY DESIGN/SETTING: This is a retrospective review of prospectively collected data from a single surgeon including micro-discectomies and lateral recess decompressions in patients younger than 60 years old using patient medical notes, radiology imaging, operation notes and PROMS including ODI (Oswestry Disability Index), VAS-BP and VAS-LP (Visual Analogue Scale for back pain & leg pain). The final follow-up was done through postal questionnaire or telephone consultation METHODS: Demographic information, duration of symptoms, type & incidence of complications, length of hospital stay and follow-up were analyzed. Data was categorized into 4 subgroups; symptoms 0 ? 6 months, 6 months ? 1 year, 1 year ? 2 years and > 2 years. A clinically significant result was an average improvement of 2 or more points in the VAS and of 20% and over in the ODI. The level of statistical significance was < 0.05%.
RESULTS: A total number of 107 patients who underwent 109 operations were included. The level of surgery was L5/S1 (50), L4/L5 (43), L3/L4 (3), L2/L3 (2) and two levels (11). The mean improvement was- 0 -? 6 months (VAS-Leg 5.21±2.81, VAS-Back 3.04±3.15, ODI 35.26±19.25), 6 months-? 1 year (VAS-Leg 4.73±2.61, VAS-Back 3.30±3.05, ODI 26.92±19.49), 1 year -?2 years (VAS-Leg 3.78±3.68, VAS-Back 3.00±2.78, ODI 19.03±20.24) and >2 years (VAS-Leg 4.77±3.61, VAS-Back 3.54±3.43, ODI 28.36±20.93). The length of hospital stay and complication rate was comparable between groups. Average follow up was 15.69 months.
CONCLUSION: Our study showed significant improvement in patients with symptoms beyond 1 as well as 2 years since onset and surgery is a viable option in selected patients.
PMID: 26940192 [PubMed – as supplied by publisher]