The Timing of Diskectomy as a Predictor of Outcomes in Patients With Lumbar Disk Herniation: A Cohort Study on Varying Durations of Preoperative Symptoms.

Abstract

Currently, the treatment of lumbar disk herniation (LDH) consists of conservative treatment followed by surgery when symptoms persist; however, the optimal timing of surgery to achieve the best clinical outcome is not clear. To evaluate the impact of durations of preoperative low back pain, disability, radicular leg pain, motor, and sensory deficit on postoperative outcomes in patients with LDH who underwent microdiskectomy. In our cohort study, we prospectively enrolled patients with different durations of preoperative LDH symptoms scheduled for microdiskectomy. The intensity and duration of radicular pain and disability were assessed using patient questionnaires. The motor deficit was classified based on the Medical Research Council scale. The sensory deficit was divided into present and absent. These parameters were assessed preoperatively and during postoperative 6-week, 6-, 12-, and 24-month follow-up visits. In total, 1222 patients with LDH were enrolled. We observed that patients with LDH who underwent surgical intervention within 1 month after the onset of symptoms achieved more favorable outcomes compared with patients with longer duration of symptoms. Residual motor and sensory deficits 2 years after surgery were least common in patients with LDH-associated neurological symptoms lasting up to 1 month. Our results support the importance of timing surgery on the postoperative outcomes of patients with LDH. Surgery for LDH within 1 month of the onset of symptoms leads to a faster improvement in neurological deficit and more significant relief from radicular pain compared with the duration of the symptoms for more than 1 month.