gms | German Medical Science

Objective: There is empirical evidence that early surgery in patients with lumbar disc herniation (LDH) and acute paresis improves the neurological outcome and reduces the recovery time. However, it remains unclear whether these patients should undergo surgery within hours after admission or whether surgery can be delayed for up to 72 hours.

Method: Retrospective analysis (01/2011–11/2013) of continuous series of adults with LDH and acute paresis rated ≤3 on 5-gr. scale undergoing the emergency surgery at our neurosurgical Dpt. Demographic characteristics, muscle power, pain and occurrence of hypesthesia were assessed at admission and in 1, 4 and 12 weeks after surgery. The postop outcome was dichotomized into 2 groups: satisfactory improvement to power ≥4/5; not satisfactory: no relevant improvement using standard methods of descriptive stat. with P<0.05 considered to be stat. significant difference.

Results: In total 295 patients were treated surgically for LDH during the study period. In the pilot stat. evaluation, a subgroup of 74 patients (01/2013–06/2013) showed acute paresis of ≤3 (n=33 female, mean age 54 years, avg. weight 78 kg, avg. height 1.73m, 36,5% smokers). There were 4.1% patients with L2/3-, 17.6% with L3/4-, 55.4% with L4/5- and 23.1% with L5/S1-disc herniation. 36.5% were localized on the right side, 60.8% on the left side and 2.7% of LDH were located medially. A typical radiculopathy was diagnosed in 98.6%, hypesthesia was spotted in 70.3% of the patients. Paresis involved iliopsoas-muscle in 21.9%, quadriceps-femoris-muscle in 21.9% patients, extensor-digitorum-longus-muscle in 68.5% cases, extensor-hallucis-longus-muscle in 57.5% cases and flexor-digitorum-longus-muscle in 9.6% of the cases. The avg. delay between the symptom onset and the surgery was 36.96 days. The avg. delay between the onset of paresis and the surgery was 7.66 days. In the multivariate analysis, adjusted for preoperative and postoperative neurological status, the odds of neurological improvement were substantially more significant amongst those who underwent early surgery (within 48h) compared to those who underwent late lumbar disc operation. There were no significant differences in the complication rates between the early surgery group and the late surgery group.

Conclusions: Early Surgery within 12 hours leads to a statistically significant better outcome in patients with lumbar disc herniation and a paresis of ≤3/5 power lasting for up to 3 days.