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

ABSTRACT: 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.

SUBMITTER: Siccoli A

PROVIDER: S-EPMC7136121 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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

Siccoli Alessandro A Wispelaere Marlies P de MP Schröder Marc L ML Staartjes Victor E VE

Neurospine 20200331 1

<h4>Objective</h4>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.<h4>Methods</h4 ...[more]

PMID: 32252169

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Project description:BackgroundLumbar disc herniation (LDH) surgery is usually recommended when conservative treatments fail to manage patients' symptoms. However, many patients undergoing LDH surgery continue to report pain and disability. Preoperative psychological factors have shown to be predictive for postoperative outcomes. Our aim was to systematically review studies that prospectively examined the prognostic value of factors in the Fear Avoidance Model (FAM), including back pain, leg pain, catastrophizing, anxiety, fear-avoidance, depression, physical activity and disability, to predict postoperative outcomes in patients undergoing LDH surgery.MethodsWe performed a systematic literature review of prospective studies that measured any FAM factors preoperatively to predict postoperative outcomes for patients undergoing LDH surgery. Our search databases included PubMed, CINAHL, and PsycINFO. We assessed the quality of each included study using a certain quality assessment list. Degree of agreement between reviewers on quality assessment was examined. Results related to FAM factors in the included studies were summarized.ResultsThirteen prospective studies met our inclusion criteria. Most studies were considered high quality. Heterogeneity was present between the included studies in many aspects. The most common FAM factors examinered were baseline pain, disability and depression. In, general, depression, fear-avoidance behaviors, passive pain coping, and anxiety FAM factors appeared to have negative influence on LDH surgical outcome. Baseline back pain and leg pain appeared to have differing prognostic value on LDH surgical outcomes.ConclusionsFAM factors seem to influence LDH surgical outcomes. Patients with high levels of depression, anxiety and fear-avoidance behaviors are more likely to have poor outcomes following LDH surgery. Conversely, high levels of leg pain, but not back pain seem to be predictor for favorable LDH surgery outcome. More research is needed to determine the exact role of FAM factors on LDH surgical outcome and the value for screening for these factors.

Dataset Information

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

Publications

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

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