Center for Spine Surgery and Research, Sygehus Lillebælt, Danmark - Østre Hougvej 55, 5500 Middelfart, Denmark; Institut for Regional Sundhedsforskning, Syddansk Universitet, Danmark - Winsløwparken 19, 3, 5000 Odense C, Denmark.
Center for Spine Surgery and Research, Sygehus Lillebælt, Danmark - Østre Hougvej 55, 5500 Middelfart, Denmark; Institut for Regional Sundhedsforskning, Syddansk Universitet, Danmark - Winsløwparken 19, 3, 5000 Odense C, Denmark.
Spine J. 2019 Sep;19(9):1463-1469. doi: 10.1016/j.spinee.2019.04.001. Epub 2019 Apr 8.
Lumbar disc herniation (LDH) is associated with great morbidity and significant socioeconomic impact in many parts of the world. Studies have shown that most LDH can be treated effectively with nonoperative management. However, for some patients in whom pain and disability are unacceptable, surgical intervention provides effective clinical relief. Currently, there is little consensus in the medical community on the timing of surgery for patients suffering from radicular pain due to LDH. Multiple studies suggest that prolonged symptom duration adversely affects clinical outcome.
The aim of this study is to evaluate if prolonged symptom duration is correlated with less favorable outcome following surgery for LDH.
STUDY DESIGN/SETTING: Consecutive series of patients from a single-center, multisurgeon, tertiary spine practice.
Consecutive series of patients who underwent surgery for LDH.
Oswestry Disability Index (ODI), EuroQol-5D (EQ-5D), and Visual Analog Scale (VAS) for back and leg pain (0-100).
Patients with a first-episode LDH were included. Data were prospectively collected in DaneSpine, the Danish National Spine Registry. Subjects were divided into three groups based on their preoperative self-reported duration of leg pain: <3 months, 3 to 12 months, and >12 months. Associations between patient-reported outcomes (PROs), perioperative complications and duration of symptoms were evaluated. Statistical significance level was set at p value <.01.
There were 2,144 patients included in the study, with complete 1-year follow-up on 1,694 patients (79%) and a reoperation rate of 8.4%. Incidence of surgical complications, specifically dural tears, was higher with increasing duration of leg pain; however, this did not reach statistical significance (p=.039). Prolonged preoperative symptoms adversely influenced all PROs (EQ-5D, ODI, VAS) 1 year after surgery (p=.001). Furthermore, reoperation rates increased with longer duration of preoperative symptoms. A statistically significant trend (p=.008) of increasing incidence of reoperation was found with increasing length of symptom duration.
Delayed surgical intervention results in inferior outcomes and increased reoperation rates. Patients who had surgery within the first 3 months of leg pain achieved significantly better outcome 1 year after surgery when compared to the other groups.
腰椎间盘突出症（LDH）在世界许多地区与高发病率和显著的社会经济影响相关。研究表明，大多数 LDH 可以通过非手术治疗有效治疗。然而，对于一些疼痛和残疾无法忍受的患者，手术干预提供了有效的临床缓解。目前，医学界对于因 LDH 引起神经根痛的患者的手术时机尚无共识。多项研究表明，症状持续时间延长会对临床结果产生不利影响。
本研究旨在评估 LDH 手术后症状持续时间与较差结果是否相关。
研究设计/设置：单中心、多外科医生、三级脊柱实践的连续患者系列。
接受 LDH 手术的连续患者系列。
Oswestry 残疾指数（ODI）、EuroQol-5D（EQ-5D）和腿部疼痛的视觉模拟量表（VAS）（0-100）。
纳入首次发作的 LDH 患者。数据在丹麦国家脊柱登记处 DaneSpine 中前瞻性收集。根据术前自述腿部疼痛持续时间，将患者分为三组：<3 个月、3-12 个月和>12 个月。评估患者报告的结果（PRO）、围手术期并发症与症状持续时间之间的关系。统计学显著性水平设置为 p 值<.01。
共有 2144 例患者纳入研究，1694 例（79%）患者完成了 1 年随访，再手术率为 8.4%。随着腿部疼痛持续时间的增加，手术并发症的发生率，特别是硬脑膜撕裂的发生率较高；然而，这并没有达到统计学意义（p=.039）。术前症状持续时间延长会对所有 PRO（EQ-5D、ODI、VAS）在手术后 1 年产生不利影响（p=.001）。此外，随着术前症状持续时间的延长，再手术率也会增加。随着症状持续时间的延长，再手术发生率呈显著上升趋势（p=.008）。
延迟手术干预会导致结果不佳和再手术率增加。与其他组相比，腿部疼痛后 3 个月内接受手术的患者在手术后 1 年获得了显著更好的结果。
