Does Surgical Timing Influence Functional Recovery After Lumbar Discectomy? A Systematic Review

• Published in: Clinical orthopaedics and related research Vol. 473; no. 6; pp. 1963 - 1970
• Main Authors: Schoenfeld, Andrew J., Bono, Christopher M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2015; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Conservative Orthopedics; Diskectomy - adverse effects; Humans; Intervertebral Disc - physiopathology; Intervertebral Disc - surgery; Intervertebral Disc Displacement - complications; Intervertebral Disc Displacement - diagnosis; Intervertebral Disc Displacement - physiopathology; Intervertebral Disc Displacement - surgery; Lumbar Vertebrae - physiopathology; Lumbar Vertebrae - surgery; Medicine; Medicine & Public Health; Orthopedics; Recovery of Function; Risk Factors; Spine; Sports Medicine; Surgery; Surgical Orthopedics; Symposium: Current Approaches to the Management of Lumbar Disc Herniation; Time Factors; Time-to-Treatment; Treatment Outcome; Oswestry Disability Index; Radiculopathy; Intervertebral Disc; Cauda Equina Syndrome; Symptom Duration
• ISSN: 0009-921X; 1528-1132; 1528-1132
• DOI: 10.1007/s11999-014-3505-1

Background The impact of the duration of preoperative symptoms on outcomes after lumbar discectomy has not been sufficiently answered in a single study but is a potentially important clinical variable. Questions/purposes A systematic review was performed to answer two questions: (1) Does symptomatic duration before surgery influence functional recovery after lumbar discectomy? (2) What is the time point for intervention beyond which the extent of postoperative recovery might be compromised? Methods The systematic review began with a query of PubMed using a structured algorithm comprised of medical subject heading terms. This was supplemented by a keyword search in PubMed along with queries of Embase, Scopus, and Web of Science and searches of reference lists as well as the tables of contents of relevant journals. Eligible studies were those that evaluated aspects of recovery after elective discectomy and stratified duration of symptoms before surgery. Included papers were abstracted by two authors and determinations regarding the period of symptom duration and its impact on outcome were recorded. Eleven studies met all inclusion criteria. No prospectively randomized trials addressed our study questions. Results Nine of 11 studies, four of which were prospective, maintained that longer symptom duration adversely impacted postsurgical recovery. There were substantial differences among the critical periods of symptom duration reported by individual studies, which ranged from 2 to 12 months. A preponderance of studies (five of nine) reported that surgical interventions could be performed at periods of 6 months or greater without impacting recovery. Conclusions Longer symptom duration had an adverse impact on results in most studies after lumbar discectomy. A possible point beyond which outcomes may be compromised is 6 months after symptom onset. Limitations in the literature surveyed, however, prevent firm conclusions.