Impact of Preoperative Symptom Duration on Patient-reported Outcomes Following Percutaneous Transforaminal Endoscopic Discectomy.

Abstract

Retrospective cohort study. To assess the impact of preoperative symptom duration on patient-reported outcomes following percutaneous transforaminal endoscopic discectomy (PTED). Lumbar disc herniation and foraminal stenosis are common conditions that can lead to debilitating radiculopathy and functional limitations. Percutaneous transforaminal endoscopic discectomy (PTED) has emerged as a minimally invasive surgical option to address these pathologies, offering potential advantages in recovery and patient satisfaction. However, the duration of preoperative symptoms has been suggested as a critical factor influencing surgical outcomes. Prolonged symptom duration may lead to nerve root inflammation, fibrosis, and chronic pain syndromes, potentially diminishing the effectiveness of surgical intervention. Patients who underwent primary 1-level or 2-level PTED with a single surgeon between 2020 and 2023 were included. Patients were grouped into shorter (<6 mo) and prolonged (≥6 mo) cohorts based on preoperative symptom duration. Outcomes included Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Back and Leg. Change in patient-reported outcome measure (PROM) scores and minimal clinically important difference (MCID) rates were calculated. Analyses were conducted on the early (within 3 mo) and late (6 mo to 2 y) postoperative periods. Eighty-three patients (63.3±15.5 y, 44.6% female) were included. Changes in ODI in the early and late postoperative periods were significantly greater for the shorter symptom duration cohort (early: 32.4±18.7 vs. 11.1±17.8, P<0.001; late: 35.9±24.1 vs. 16.9±16.5, P=0.002). The shorter symptom duration cohort achieved MCID for ODI at a significantly greater rate in the early postoperative period (85.2% vs. 44.4%, P<0.001). Prolonged preoperative symptom duration (≥6 mo) was identified as an independent risk factor for failure to achieve MCID at the latest timepoint for ODI (OR: 10.1, 95% CI: 2.6-39.8, P<0.001) and VAS-Leg (OR: 5.9, 95% CI: 1.1-31.2, P=0.037). Our study demonstrates improved clinical outcomes for patients with shorter preoperative symptom duration undergoing endoscopic lumbar discectomy, suggesting that delayed surgical intervention may result in poorer outcomes and greater postoperative disability. These findings may help inform the approach to counseling patients on postoperative expectations and outcomes based on their preoperative symptom duration. Level III.