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Longer duration of symptoms linked to poor outcomes for patients with disc herniation
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NEW ORLEANS — The longer a patient has to wait for treatment – either operative or nonoperative – for intervertebral lumbar disc herniation, the worse their outcomes will be, according to a study presented here.
Mark F. Kurd, MD, presented the research at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons.
In their study, Kurd and colleagues attempted to determine the impact of delayed treatment on patients with intervertebral lumbar disc herniation.
“The efficacy of lumbar discectomy has been well demonstrated,” he said. “However, there still is a lack of consensus regarding the timing of discectomy. The literature suggests waiting anywhere from a reasonable amount of time to about 12 months for surgical intervention.”
Study methods and results
Kurd’s team performed an as-treated analysis on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of intervertebral disc herniation. They compared 927 patients with less than or equal to 6 months of pre-treatment duration of symptoms and 265 patients with greater than 6 months of symptoms. They measured primary and secondary outcomes at baseline and at regular follow-up intervals for up to 4 years.
Kurd noted that all primary outcome measures were significantly worse in patients with a duration of symptoms greater than 6 months for both operative and nonoperative treatments.
“Patients in the early treatment group had significantly better outcomes than those in the late treatment group,” he said.
Further notes
The treatment effects, Kurd reported, were statistically significant in favor of surgery within each group at follow-up intervals for all primary and secondary outcome measures.
“Patients with greater than 6 months of symptoms certainly had worse outcomes – whether treated surgically or nonsurgically, and when evaluating the treatment effect, the benefit of surgery was similar regardless of duration of symptoms,” Kurd concluded.
- Reference:
Rihn J, Hilibrand AS, Blood E, et al. Does the duration of symptoms affect outcomes in the treatment of lumbar disc herniation? Paper #61. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13. New Orleans.
