gms | German Medical Science

Objective: To evaluate the clinical presentation, course and outcome of patients coming to the emergency department, suffering from radicular pain with or without neurological deficits due to disc herniation, and being treated emergently within 24 hours.

Method: A retrospective analysis of 526 consecutive patients with radicular pain with or without neurological deficits, who had been admitted to the emergency department between January 2004 and September 2013 was carried out. The charts were screened for presenting symptoms, treatment, and neurologic status preoperatively, at discharge and 6 weeks after. Exclusion criteria were conservative treatment or surgical therapy > 24 hours after admission, radiculopathy due to fractures, spinal hematoma, spine tumors, spondylolisthesis, spondylitis, facet joint syndrome or juxtafacet cysts.

Results: 80 patients (49 male, 31 female; mean age 46.5 years) underwent emergency surgery within 24 hours. T. Imaging showed a lumbar disc herniation in 72 cases, a cervical disc herniation in 8 cases. The most common presenting symptom was extreme radicular pain (n=76). Lasègue's sign was positive in 68, radicular sensory deficits in 64 and motor deficits in 53 patients. Perineal numbness was present in 11 patients, bladder and/or bowel incompetence in 12 patients. At discharge radiculopathy, motor deficits, and bladder and/or bowel incompetence had improved significantly (p<0.001, p=0.030 and p=0.015, resp.). Sensory deficits and perineal numbness have not improved significantly until discharge. After 6 weeks sensory deficits recovered significantly (p=0.003), merely. Motor deficits, perineal numbness, and bladder and/or bowel incompetence persisted.

Conclusions: During inpatient treatment pain, motor deficits and bowel and bladder dysfunction improved significantly. Radicular sensory deficits recovered significantly after 6 weeks. Thus, we advocate that immediate surgery in patients with extreme pain and progressive motor/vegetative symptoms is superior to attempts of conservative treatment in patients with acute disc herniation.