Surgical treatment within six months of lumbar disc herniation

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 Jeffrey A. Rihn, MD, 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 material that is pressing on a or the 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 ," 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 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."

add to favorites email to friend print save as pdf

Related Stories

Back to normal: Surgery improves outcomes for spine patients

Jun 01, 2009

People with the spine disease called degenerative spondylolisthesis* -- who choose surgical treatment -- experience substantially greater relief from pain over time compared to those who do not have surgery, according to ...

Recommended for you

Ebola death toll passes 7,500

1 hour ago

More than 7,500 people have now died from the Ebola virus, as the number of cases climbs towards 20,000, the World Health Organization said Monday.

Ebola-infected Italian doctor 'recovering'

2 hours ago

An Italian doctor who contracted Ebola in west Africa is recovering but is still in an isolation unit, the specialist clinic in Rome treating him said Monday.

Restrictions lifted at British bird flu farm

Dec 21, 2014

Britain on Sunday lifted all restrictions at a duck farm in northern England after last month's outbreak of H5N8 bird flu, the same strain seen in recent cases across Europe.

User comments

Adjust slider to filter visible comments by rank

Display comments: newest first

jerryd
not rated yet Oct 25, 2011

Surprise, surprise that surgeons would find surgery works much better when it also can go so wrong. I have this condition and the risks of surgery vs the benefit isn't good.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.