Abstract
Objective: To determine the late (2–5 years) clinical results of surgery for herniated lumbar disc (HLD) as related to duration of preoperative symptoms and type of herniation.
Methods: The study was limited to 63 adult Moslem Arab residents of the hospital’s catchment area. All subjects had been scored for pre and postoperative leg pain and for related disability using a 0–11 visual analog scale and a functional grading system (Spangfort’s), respectively. Relationships between duration of preoperative symptoms and extent of disc herniation with the above scores were statistically analyzed.
Results: The mean overall score for leg pain decreased from 7.2 ± 2.0 (preoperatively) to 3.4 ± 2.4, a mean reduction (ΔVAS) of 3.1 ± 2.7, a 43.3% change (P< 0.001). Patients operated upon within 4 weeks after onset of symptoms attained the highest degree of leg pain relief (ΔVAS 4.3 ± 2.6), those operated within 4–12 weeks reported the least relief of leg pain (ΔVAS 1.7 ± 2.8). Paradoxically, patients who underwent surgery after 12 weeks received better results than the 4 – 12 week group (ΔVAS 3.0 ± 1.3). Patients with non-contained herniation reported a more intense preoperative leg pain than those defined as contained (VAS 8.3 vs. 6.5), were operated earlier (7.4 vs. 15.8 weeks), and their functional outcome was graded as better (Good/Fair in 96.4% vs. 74.3%).
Conclusions: Patients with incapacitating radicular pain, not responding to conservative treatments, are best operated upon within 6 weeks of onset. Surgery for non-contained herniation achieves a higher long-term success rate, probably since severe pain hastens surgical procedure, thereby preventing irreversible root damage.
The abstracts were prepared by Ms Orah Naor. Correspondence should be addressed to Israel Orthopaedic Association at PO Box 7845, Haifa 31074, Israel.
