Surgical Treatment Within Six Months of Lumbar Disc Herniation Symptoms Associated With Improved Outcomes

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American Academy of Orthopaedic Surgeons

Oct 26, 2011, 10:08 ET

Findings may help patients and doctors make more informed treatment decisions

ROSEMONT, Ill., Oct. 26, 2011 /PRNewswire-USNewswire/ -- A new study in the Journal of Bone and Joint Surgery (JBJS) found that patients with herniated lumbar disc symptoms were significantly worse if the patients had symptoms for more than six months prior to treatment, compared to those who had symptoms for six months or less. Symptoms included pain, function, general health, work status and patient satisfaction.

"Patients often ask their physicians whether the duration of their symptoms will affect their potential for a full recovery, and the goal of our study was to address this question," said orthopaedic surgeon Jeffrey A. Rihn, M.D., and one of the study authors.

Several studies conducted over the past 30 years have demonstrated the effectiveness of lumbar discectomy. One of the most common spinal surgical procedures, lumbar discectomy involves the removal of the herniated disc material that is pressing on a nerve root or the spinal canal to treat lumbar disc herniation. However, despite the proven effectiveness of this procedure, there is no consensus on the timing of surgery. Various studies suggest waiting anywhere from "an appropriate amount of time" to 12 months after symptoms begin.

"According to our study and generally speaking, patients who had symptoms for more than six months had less improvement in pain, function, general health, work status, and patient satisfaction," said Dr. Rihn.

Study Details

The study authors observed 1,192 patients enrolled in the Spine Patient Outcomes Research Trial (SPORT), which was conducted at 13 multidisciplinary spinal practices in 11 states.
The patients were older than age 18 and suffered from various symptoms of lumbar disc herniation.
Patients were assigned to undergo either operative treatment—lumbar discectomy—or nonoperative treatment—such as physical therapy, education, a nonsteroidal anti-inflammatory drug, and/or counseling with home exercise instruction.
The patients completed questionnaires at the beginning of the study and at follow-up intervals—six weeks, three months, six months, one year, two years, and four years after treatment. Using various tools, the study authors analyzed the outcomes of the operative and nonoperative treatments. They compared the treatment outcomes of the 927 patients who had symptoms for six months or less to those of the 265 patients who had symptoms for more than six months prior to enrolling in the study.

At all follow-up intervals, outcomes were significantly worse in patients who had symptoms for more than six months prior to treatment than in those who had symptoms for six months or less.

The study authors also found that operative treatment was significantly more effective than nonoperative treatment. However, the relative increased benefit of surgery over nonoperative treatment was not dependent on the duration of symptoms.

"Patients who have had symptoms for longer than six months can find relief with either nonoperative treatment or surgery, but they may not reap as much benefit as those who have had symptoms for six months or less," said Dr. Rihn. "Surgery still has significant benefit compared with nonsurgical treatment, even in patients who have had symptoms for longer than six months."

Further research exploring the effect of the duration of symptoms on treatment outcomes is warranted, according to Dr. Rihn.

About lumbar disc herniation
Lumbar disc herniation is a condition in which all or part of the jelly-like material in the center of a disc between two vertebrae in the lower back is forced through a weakened area of the disc. When the disc herniates, it can cause back pain and, if it pushes on a nerve root, can cause pain, numbness, tingling, and/or weakness in one or both legs. One of the most common and debilitating conditions of the spine, symptomatic lumbar disc herniation affects 1 to 2 percent of the population at some point in their lives, most often people in their 30s and 40s.

Symptoms of lumbar disc herniation often improve within six to eight weeks. For this reason, treatment of the condition typically initially involves nonsurgical approaches, such as medications, education, counseling, and physical therapy. According to most guidelines, surgery should only be considered for patients who experience pain beyond a reasonable course of nonoperative therapy or who have progressive muscle weakness, loss of feeling or loss of bladder or bowel control from the nerve compression.

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the 36 months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work.

The American Academy of Orthopaedic Surgeons (AAOS) has more information on back pain and treatment options, which can be found at www.orthoinfo.org.

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SOURCE American Academy of Orthopaedic Surgeons