BACKGROUND: Patients with a lumbar disc herniation (LDH) without high-grade neurological deficit (PWN) are usually treated non-operatively. If non-operative treatment is not successful, a postponed surgical treatment is performed. Postponed surgery is reported to show later improvement of pain and health-related quality of life and later return to work than early surgery. There are presently no objective parameters to predict if non-operative treatment may be successful in PWN, or if an early surgical treatment could be performed. METHODS: To analyze if high-grade spinal canal stenosis lead to a higher rate of surgical treatment in PWN, we conducted a retrospective single-center cohort study and included PWN with acute onset of severe radicular pain (VAS ≥8). We excluded patients with workers' compensation involvement, chronic pain syndrome, motor deficit <3/5, malignancy and history of prior spinal surgery. All patients were initially treated by the same standardized non-operative treatment. It was monitored if patients eventually choose an operative treatment or not. After a power analysis (aiming at >0.8), 1,053 consecutive patients (02.2008 to 12.2017) were identified by diagnostic code. One hundred and eight patients were enrolled in our investigation. Thirty-nine patients were treated non-operatively (Group 1), 69 were treated by operation (Group 2). RESULTS: Percent (%) spinal canal compromise based on cross-sectional area of LDH was 26.3% in Group 1, 33.7% in Group 2. The difference was significant (P<0.025). CONCLUSIONS: The investigated group of PWN had a significantly higher probability to need surgical treatment if they had a high-grade stenosis of the spinal canal. However, these results do not constitute a general indication for surgical treatment of PWN. The results of this study merely provide information for patients, and spine specialists, to be implemented in an individual decision-process that leads to a recommendation for type of treatment. 2020 Journal of Spine Surgery. All rights reserved.
BACKGROUND: Patients with a lumbar disc herniation (LDH) without high-grade neurological deficit (PWN) are usually treated non-operatively. If non-operative treatment is not successful, a postponed surgical treatment is performed. Postponed surgery is reported to show later improvement of pain and health-related quality of life and later return to work than early surgery. There are presently no objective parameters to predict if non-operative treatment may be successful in PWN, or if an early surgical treatment could be performed. METHODS: To analyze if high-grade spinal canal stenosis lead to a higher rate of surgical treatment in PWN, we conducted a retrospective single-center cohort study and included PWN with acute onset of severe radicular pain (VAS ≥8). We excluded patients with workers' compensation involvement, chronic pain syndrome, motor deficit <3/5, malignancy and history of prior spinal surgery. All patients were initially treated by the same standardized non-operative treatment. It was monitored if patients eventually choose an operative treatment or not. After a power analysis (aiming at >0.8), 1,053 consecutive patients (02.2008 to 12.2017) were identified by diagnostic code. One hundred and eight patients were enrolled in our investigation. Thirty-nine patients were treated non-operatively (Group 1), 69 were treated by operation (Group 2). RESULTS: Percent (%) spinal canal compromise based on cross-sectional area of LDH was 26.3% in Group 1, 33.7% in Group 2. The difference was significant (P<0.025). CONCLUSIONS: The investigated group of PWN had a significantly higher probability to need surgical treatment if they had a high-grade stenosis of the spinal canal. However, these results do not constitute a general indication for surgical treatment of PWN. The results of this study merely provide information for patients, and spine specialists, to be implemented in an individual decision-process that leads to a recommendation for type of treatment. 2020 Journal of Spine Surgery. All rights reserved.
Entities:
Keywords:
Lumbar disc herniation (LDH); MRI; indication; outcome; surgery; treatment; volume of lumbar disc herniation (volume of LDH)
Authors: Jon D Lurie; Tor D Tosteson; Anna N A Tosteson; Wenyan Zhao; Tamara S Morgan; William A Abdu; Harry Herkowitz; James N Weinstein Journal: Spine (Phila Pa 1976) Date: 2014-01-01 Impact factor: 3.468
Authors: Ondra Petr; Bernhard Glodny; Konstantin Brawanski; Johannes Kerschbaumer; Christian Freyschlag; Daniel Pinggera; Rafael Rehwald; Sebastian Hartmann; Martin Ortler; Claudius Thomé Journal: Spine (Phila Pa 1976) Date: 2019-04-01 Impact factor: 3.468