Abstract
To quantify the duration of symptoms and the treatment modalities employed prior to surgery in patients undergoing lumbar and cervical nerve root decompression and to assess the evidence of these non-surgical treatments.
Pre- and post operative questionnaires completed by consecutive patients.
514 people undergoing consecutive cervical or lumbar nerve root decompression between March 2007 to October 2009.
Pre-operative severity and duration of pain, functional limitations and treatment received. Post-operative pain severity and change in functional limitations.
Evidence in the literature for efficacy of treatment modalities employed.
Mean duration of pre-operative symptoms was 23 months (range 1 to 360). 91% took regular medication for pain, 83% received one or more physical therapy, 24% received injection therapy.
There was improvement in both pain scores (mean pre-op 7.3; post-op 3.0) and 78% of the commonly reported functional limitations, walking, sleep and work.
We found extremely limited evidence to support the other treatment modalities employed.
Patients spend many months unnecessarily in pain, consuming considerable resources and may suffer significant side effects from ineffective treatment for pain emanating from nerve root compression. Surgical nerve root decompression relieves pain and restores function. Despite this a specialist opinion is often delayed. Early referral for specialist opinion is almost certainly more humane, cost effective, and time-limits the journey on the not so magic roundabout.
