#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

It is evident when to make a surgery for lumbar disc herniation?


Authors: Z. Kadaňka Jr. 1;  Z. Kadaňka 1;  M. Smrčka 2;  J. Bednařík 1
Authors‘ workplace: Neurologická klinika LF MU a FN Brno 1;  Neurochirurgická klinika LF MU a FN Brno 2
Published in: Cesk Slov Neurol N 2020; 83/116(4): 360-363
Category: Review Article
doi: https://doi.org/10.14735/amcsnn2020360

Overview

The literature supports both conservative management and surgical intervention as viable options for the treatment of radiculopathy caused by lumbar disc herniation. However, the majority of available literature is limited to retrospectives, meta-analyses or literature reviews. Methodological drawbacks and difficulties limit the effect of performed prospective, randomized, controlled trials. That may be the reason why no “gold standard” treatment has yet been established. Surgery may result in faster relief from pain than conservative treatment and earlier restoration of the function of the affected root, although long-term results appear to be similar regardless the type of management. The optimal timing of elective surgery is not clear; only a broad time frame (2–12 months) could be derived from the review of literature; a preponderance of studies reported that surgical interventions should be performed within 6 months. We usually prefer 6–7 weeks in the case of failure of conservative treatment. The current available evidence is not robust enough for answering the question in which time period can surgical intervention be effective in patient with paresis due to herniated lumbar disc. Although the evidence is still lacking, we feel that in patients with unbearable pain and severe paresis, we should prefer early surgical intervention. Age, initial severity of neurological deficit, sensory involvement, the duration of paresis has been postulated to influence neurological recovery.

Keywords:

sciatica – radiculopathy – disc herniation – lumbar degenerative disease – discectomy – microdiscectomy


Sources

1. Nygaard ØP, Kloster R, Solberg T. Duration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow up. J Neurosurg 2000; 92 (2 Suppl): 131–134. doi: 10.3171/spi.2000.92.2.0131.

2. Siccoli A, Staartjes VE, de Wispelaere MP et al. Association of time to surgery with leg pain after lumbar discectomy: is delayed surgery detrimental? J Neurosurg Spine 2019; 32 (2): 160–167. doi: 10.3171/2019.8.SPINE19613.

3. Akagi R, Aoki Y, Ikeda Y et al. Comparison of early and late surgical intervention for lumbar disc herniation: is earlier better? J Orthop Sci 2010; 15 (3): 294–298. doi: 10.1007/s00776-010-1457-1.

4. Atlas SJ, Keller RB, Wu YA et al. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976) 2005; 30 (8): 927–935. doi: 10.1097/01.brs.0000158954.68 522.2a.

5. Kerr D, Zhao W, Lurie JD. What are long-term predictors of outcomes for lumbar disc herniation? A randomized and observational study. Clin Orthop Relat Res 2015; 473 (6): 1920–1930. doi: 10.1007/s11999-014-3803-7.

6. Chiu CC, Chuang TT, Chang KH et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil 2015; 29 (2): 184–195. doi: 10.1177/0269215514540919.

7. Peul WC, Arts MP, Brand R et al. Timing of surgery for sciatica: subgroup analysis alongside a randomized trial. Eur Spine J 2009; 18 (4): 538–545. doi: 10.1007/s00586-008-0867-7.

8. Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine 2007; 32 (16): 1735–1747. doi: 10.1097/BRS.0b013e3180bc2431.

9. Hahne AJ, Ford JJ, McMeeken JM. Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine (Phila Pa 1976) 2010; 35 (11): E488–E504. doi: 10.1097/BRS.0b013e3181cc3 f56.

10. Delgado-López PD, Rodríguez-Salazar A, Martín--Alonso J et al. [Lumbar disc herniation: Natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests]. Neurocirugia (Astur) 2017; 28 (3): 124–134. doi: 10.1016/j.neucir.2016.11. 004.

11. Sabnis AB, Diwan AD. The timing of surgery in lumbar disc prolapse: a systematic review. Indian J Orthop 2014; 48 (2): 127–135. doi: 10.4103/0019-5413.128740.

12. Alentado VJ, Lubelski D, Steinmetz MP et al. Optimal duration of conservative management prior to surgery for cervical and lumbar radiculopathy: a literature review. Global Spine J 2014; 4 (4): 279–286. doi: 10.1055/s-0034-1387807.

13. Smrcka M, Baudysová O, Jurán V et al. Lumbar disc surgery in regional anaesthesia – 40 years of experience. Acta Neurochir (Wien) 2001; 143 (4): 377–381. doi: 10.1007/s007010170093.

14. Schoenfeld AJ, Bono CM. Does surgical timing influence functional recovery after lumbar discectomy? A systematic review. Clin Orthop Relat Res 2015; 473 (6): 1963–1970. doi: 10.1007/s11999-014-3505-1.

15. Rihn JA, Hilibrand AS, Radcliff K et al. Duration of Symptoms resulting from lumbar disc herniation: effect on treatment outcomes. J Bone Joint Surg Am 2011; 93 (20): 1906–1914. doi: 10.2106/JBJS.J.00878.

16. Omidi-Kashani F, Ghayem Hasankhani E, Kachooei AR et al. Does duration of preoperative sciatica impact surgical outcomes in patients with lumbar disc herniation? Neurol Res Int 2014; 2014: 565189. doi: 10.1155/2014/565189.

17. Fernandez M, Ferreira ML, Refshauge KM et al. Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis. Eur Spine J 2016; 25 (11): 3495–3512. doi: 10.1007/s00586-015-4148-y.

18. Rahmathulla G, Kamian K. Lumbar disc herniations “To operate or not” patient selection and timing of surgery. Korean J Spine 2014; 11 (4): 255–257. doi: 10.14245/kjs.2014.11.4.255.

19. Weinstein JN, Lurie JD, Tosteson TD et al. Surgical vs nonoperative treatment for lumbar disk herniation. JAMA 2006; 296 (20): 2451–2459. doi: 10.1001/jama.296.20. 2451.

20. Masuda S, Kanba Y, Kawai J et al. Prognostic factors for drop foot due to lumbar degenerative diseases: the impact of surgical timing on postoperative recovery. Clin Spine Surg 2020; 33 (4): 160–162. doi: 10.1097/BSD. 0000000000000882.

21. Postacchini F, Giannicola G, Cinotti G. Recovery of motor deficits after microdiscectomy for lumbar disc herniation. J Bone Joint Surg Br 2002; 84 (7): 1040–1045. doi: 10.1302/0301-620x.84b7.12948.

22. Petr O, Glodny B, Brawanski K et al. Immediate versus delayed surgical treatment of lumbar disc herniation for acute motor deficits: the impact of surgical timing on functional outcome. Spine (Phila Pa 1976) 2019; 44 (7): 454–463. doi: 10.1097/BRS.0000000000002295.

23. Bhargava D, Sinha P, Odak S et al. Surgical Outcome for foot drop in lumbar degenerative disease. Global Spine J 2012; 2 (3): 125–128. doi: 10.1055/s-0032-1326947.

24. Iizuka Y, Iizuka H, Tsutsumi S et al. Foot drop due to lumbar degenerative conditions: mechanism and prognostic factors in herniated nucleus pulposus and lumbar spinal stenosis. J Neurosurg Spine 2009; 10 (3): 260–264. doi: 10.3171/2008.12.SPINE08500.

25. Liu K, Zhu W, Shi J et al. Foot drop caused by lumbar degenerative disease: clinical features, prognostic factors of surgical outcome and clinical stage. PLoS One 2013; 8 (11): e80375. doi: 10.1371/journal.pone.0080375.

26. Nakashima H, Ishikawa Y, Kanemura T et al. Neurological function following early versus delayed decompression surgery for drop foot caused by lumbar degenerative diseases. J Clin Neurosci 2020; 72: 39–42. doi: 10.1016/j.jocn.2020.01.039.

27. Dubourg G, Rozenberg S, Fautrel B et al. A pilot study on the recovery from paresis after lumbar disc herniation. Spine 2002; 27 (13): 1426–1431; discussion 1431. doi: 10.1097/00007632-200207010-00010.

28. Balaji VR, Chin KF, Tucker S et al. Recovery of severe motor deficit secondary to herniated lumbar disc prolapse: is surgical intervention important? A systematic review. Eur Spine J 2014; 23 (9): 1968–1977. doi: 10.1007/s00586-014-3371-2.

29. Delgado-Lo Pez PD, Rodri Guez-Salazar A, Castilla-Di Ez JM et al. [Role of surgery in spinal degenerative disease. Analysis of systematic reviews on surgical and conservative treatments from an evidence-based approach]. Neurocirugia (Astur) 2005; 16 (2): 142–157. doi: 10.1016/s1130-1473 (05) 70420-6.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 4

2020 Issue 4

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#