Is the surgical outcome for lumbar disc herniation related to the duration of symptoms?

Background:
Lumbar disc herniation (LDH) is associated with great morbidity and significant socio-economic impact in many parts of the world. Studies have shown that most LDH can be treated effectively with conservative management and the passage of time. However for the group of patients where pain and disability is unacceptable, surgical intervention provides effective clinical relief in many cases. Currently there is little consensus in the medical community on the timing of surgery for patients suffering from radicular pain due to LDH. Reports based on the SPORT database indicate that prolonged symptom-duration correlates with inferior outcome.

Purpose / Aim of Study:
The aim of this study is to evaluate if prolonged symptom-duration is correlated with less favorable outcome following surgery for LDH in a Single- Center Study.

Materials and Methods:
832 patients with first-time LDH were included in a Single-Center Study. Data were prospectively collected in DaneSpine, the Danish National Spine Register. The patient reported outcome measures (PROM) EQ5D, SF36, ODI, VAS-leg and -back were correlated with duration of symptoms.

Findings / Results:
832 patients were included in the study, with complete one-year follow-up on 664 patients (80%) and a reoperation rate of 6%. The duration of symptoms have a negative correlation on all patient related outcome measures.

Conclusions:
Delayed surgical intervention results in inferior patient related outcome. Our results indicate that patients operated within the first 3 months of leg-pain achieve best outcome.