Friday, September 28, 2018 3:00 PM–4:00 PM abstracts: optimizing lumbar disc surgery: 217. Increasing reoperation rates and inferior outcome with prolonged symptom duration in lumbar disc herniation surgery

Abstract

BACKGROUND CONTEXT Lumbar disc herniation (LDH) is associated with great morbidity and significant socio-economic impact in many parts of the world. Studies have shown that most LDH can be treated effectively with nonoperative management. However, for some patients where pain and disability is unacceptable, surgical intervention provides effective clinical relief. Currently there is little consensus in the medical community on the timing of surgery for patients suffering from radicular pain due to LDH. Multiple studies suggest that prolonged symptom duration adversely affects clinical outcome. PURPOSE The aim of this study is to evaluate if patients with prolonged preoperative symptom duration will have less favorable outcome following surgery for LDH. STUDY DESIGN/SETTING Consecutive series of patients from a single-center, multisurgeon, teritiary spine practice. PATIENT SAMPLE Consecutive series of patients scheduled for spine surgery. OUTCOME MEASURES Oswestru Disability Index (ODI), EuroQol-5D (EQ-5D) and Visual Analog Scale (VAS) for back and leg pain (0–100). METHODS Patients with first episode LDH were included in a single-center study. Data were prospectively collected in DaneSpine, the Danish National Spine Registry. Subjects were divided into three groups based on their self-reported duration of leg pain prior to enrollment into the registry: <3-months, 3-12 months and >12-months. Associations between patient-reported outcomes (PROs), perioperative complications and duration of symptoms were evaluated. RESULTS A total of 1,834 patients were included in the study, with complete 1-year follow-up on 1,448 patients (79%) and an overall reoperation rate of 8.4%. Incidence of surgical complications, specifically dural tears, was higher with increasing duration of leg pain, however, this did not reach statistical significance (p=.028). Prolonged preoperative symptoms adversely influenced all PROs (EQ-5D, ODI, VAS) 1 year after surgery (p=.001). Furthermore, reoperation rates increased with longer duration of preoperative symptoms. A statistically significant trend (p=.009) of increasing incidence of reoperation was found with increasing length of symptom duration. CONCLUSIONS Delayed surgical intervention results in inferior clinical outcomes and increased reoperation rates. Patients who had surgery within the first 3 months of leg pain achieved the best outcome 1 year after surgery. Lumbar disc herniation (LDH) is associated with great morbidity and significant socio-economic impact in many parts of the world. Studies have shown that most LDH can be treated effectively with nonoperative management. However, for some patients where pain and disability is unacceptable, surgical intervention provides effective clinical relief. Currently there is little consensus in the medical community on the timing of surgery for patients suffering from radicular pain due to LDH. Multiple studies suggest that prolonged symptom duration adversely affects clinical outcome. The aim of this study is to evaluate if patients with prolonged preoperative symptom duration will have less favorable outcome following surgery for LDH. Consecutive series of patients from a single-center, multisurgeon, teritiary spine practice. Consecutive series of patients scheduled for spine surgery. Oswestru Disability Index (ODI), EuroQol-5D (EQ-5D) and Visual Analog Scale (VAS) for back and leg pain (0–100). Patients with first episode LDH were included in a single-center study. Data were prospectively collected in DaneSpine, the Danish National Spine Registry. Subjects were divided into three groups based on their self-reported duration of leg pain prior to enrollment into the registry: <3-months, 3-12 months and >12-months. Associations between patient-reported outcomes (PROs), perioperative complications and duration of symptoms were evaluated. A total of 1,834 patients were included in the study, with complete 1-year follow-up on 1,448 patients (79%) and an overall reoperation rate of 8.4%. Incidence of surgical complications, specifically dural tears, was higher with increasing duration of leg pain, however, this did not reach statistical significance (p=.028). Prolonged preoperative symptoms adversely influenced all PROs (EQ-5D, ODI, VAS) 1 year after surgery (p=.001). Furthermore, reoperation rates increased with longer duration of preoperative symptoms. A statistically significant trend (p=.009) of increasing incidence of reoperation was found with increasing length of symptom duration. Delayed surgical intervention results in inferior clinical outcomes and increased reoperation rates. Patients who had surgery within the first 3 months of leg pain achieved the best outcome 1 year after surgery.