Early surgery determines recovery of motor deficits in lumbar disc herniations\u2014a prospective single-center study

Nikolaus Kögl,Konstantin Brawanski,Pierre-Pascal Girod,Claudius Thomé,Ondra Petr

doi:10.1007/s00701-020-04614-0

Nikolaus Kögl, Konstantin Brawanski + Show 3 more

Open Access

https://doi.org/10.1007/s00701-020-04614-0

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Abstract

BackgroundPatients with intervertebral disc herniation undergo surgical removal of herniated disc material in cases of persisting symptoms and/or neurologic deficits. While motor deficits often prompt surgery, little is known about the optimal timing of surgery in these cases. The aim of this study was to prospectively evaluate the impact of timing of disc surgery on motor recovery. Does postponing surgical treatment worsen outcome?MethodIn total, 120 patients with sciatica and/or sensorimotor deficits due to a lumbar disc herniation were surgically treated at the authors’ center within a 3-month period. In 60 patients, motor deficits were present at the time of admission. Motor function was assessed using manual muscle testing and subdivided according to the Medical Research Council (MRC) scale. Patient demographics, neurologic deficits, duration of motor deficits, treatment characteristics, and outcome were assessed. At a minimum follow-up of 1 year, functional recovery and complications were collated. Patients were subdivided into groups according to the severity of the paresis (MRC ≤ 3/5 vs. MRC 4/5). Intra-group differences were compared based on the duration of the neurologic deficits.ResultsPatients with moderate and severe paresis (MRC ≤ 3/5) benefit from treatment within 72 h as they were shown to have a significantly higher complete recovery rate at 1-year follow-up (75% vs. 0%; p < 0.001).ConclusionImmediate surgery should be offered to patients with moderate and severe motor deficits to increase the likelihood of neurologic recovery. This prospective data may have an impact on emergency triage in these patients.

Highlights

The most common cause of sciatica is intervertebral disc herniation or spondylosis leading to mechanical nerve affection [6, 15]
A multicenter registry study designed to evaluate the need for an annular closure device (ACD) prospectively assessed lumbar disc herniation patients
In accordance with clinical guidelines, patients were subdivided into groups according to the severity of the paresis (MRC ≤ 3/5 vs. Medical Research Council (MRC) 4/5) [20]

Summary

Introduction

The most common cause of sciatica is intervertebral disc herniation or spondylosis leading to mechanical nerve affection [6, 15]. In approximately 20% of cases, patients undergo surgical removal of herniated disc material because of persisting symptoms, which is usually done within 6–26 weeks in western countries as surgery is economically. This article is part of the Topical Collection on Spine degenerative Neurological deficits such as paresis can be seen in up to 30 to 50% of patients with symptomatic disc herniation [25]. Patients with intervertebral disc herniation undergo surgical removal of herniated disc material in cases of persisting symptoms and/or neurologic deficits. Method In total, 120 patients with sciatica and/or sensorimotor deficits due to a lumbar disc herniation were surgically treated at the authors’ center within a 3-month period. Neurologic deficits, duration of motor deficits, treatment characteristics, and outcome were assessed. Intra-group differences were compared based on the duration of the neurologic deficits

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