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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Immediate versus delayed surgical treatment of cervical disc herniation for acute motor deficits – the impact of surgical timing on functional outcome

Einfluss des Operationszeitpunkts auf das funktionelle Outcome bei cervikalen Diskushernien mit Schwerpunkt auf motorischen Defiziten

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Ondra Petr - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • presenting/speaker Fabian Kompatscher - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • presenting/speaker Alice Görke - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Nikolaus Kögl - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Konstantin Brawanski - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Christian Preuß Hernández - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Claudius Thomé - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP140

doi: 10.3205/19dgnc477, urn:nbn:de:0183-19dgnc4774

Veröffentlicht: 8. Mai 2019

© 2019 Petr et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: The aim of the study was to assess the impact of timing of surgery in patients with cervical disc herniation (CDH) and CDH-related motor deficits (MDs) on functional outcome. The current single-center study presents results of emergency or urgent surgery for CDH in a group of patients with acute paresis in a “real-world” setting.

MD are a frequent symptom of CDH. While surgery within 48 hours has been recommended for cauda-equina syndrome and lumbar disc herniations with acute moderate or severe paresis, the optimal timing of surgery for acute MDs related to CDH continues to be debated. Early surgery has been proposed but remains to be unproven.

Methods: 106 patients with acute paresis due to CDH acutely referred to our Department and surgically treated using anterior cervical discectomy or posterior cervical foraminotomy from 01/2012–12/2017 were included.

Based on the duration of MD and surgical timing, patients were classified into two categories: Group I included all patients with a paresis<48h and Group II >48h. Patient demographics, CDH/clinical/treatment characteristics, and outcomes were collected prospectively. Severity of paresis (MRC 0-4), surgery-related complications, functional recovery of motor/sensory deficits, retreatment/recurrence rates, and overall neurological outcome were analyzed.

Results: Group I showed significantly faster recovery of acute paresis <48h at 6-weeks/3-months and 6-months follow-ups (88.5% versus 60.3%, P=0.002, and 96.2% versus 68.8%, P=0.005, respectively) and, while there was a clear trend towards higher recovery rates at time of discharge in the Group I (41.3% versus 11.5%, P=0.054).

Conclusion: Given the superior rates of neurological recovery of acute MDs, immediate surgery should be the primary option. Yet, a prospective randomized clinical trial is needed to confirm the superiority of emergency surgery.