Does Surgical Timing Influence Functional Recovery After Lumbar Discectomy? A Systematic Review

Schoenfeld, Andrew J.; Bono, Christopher M.

doi:10.1007/s11999-014-3505-1

Cited by 41 publications

(24 citation statements)

References 12 publications

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“…Inconsistent findings identified that duration leg pain was not associated with patient outcome [Pain Disability Score, ODI, leg pain, back pain and Clinical Overall Score at 12 months; EQ-5D at 2 and 7 years]. This was in contrast to previous reviews that identified pre-operative duration of leg pain as associated with patient outcome [14,15]. It is however difficult to have confidence in the findings from previous reviews as they themselves were at risk of bias.…”

Section: Discussioncontrasting

confidence: 72%

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Physical prognostic factors predicting outcome following lumbar discectomy surgery: systematic review and narrative synthesis

Rushton

Zoulas²,

Powell³

et al. 2019

Physiotherapy

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Background: Success rates for lumbar discectomy are estimated as 78-95% patients at 1-2 years post-surgery, supporting its effectiveness. However, ongoing pain and disability is an issue for some patients, and recurrence contributing to reoperation is reported. It is important to identify prognostic factors predicting outcome to inform decision-making for surgery and rehabilitation following surgery. The objective was to determine whether pre-operative physical factors are associated with post-operative outcomes in adult patients [≥16 years old] undergoing lumbar discectomy or microdiscectomy.Methods: A systematic review was conducted according to a registered protocol [PROSPERO CRD42015024168]. Key electronic databases were searched [PubMed, CINAHL, EMBASE, MEDLINE, PEDro and ZETOC] using pre-defined terms [e. g. radicular pain] to 31/3/2017; with additional searching of journals, reference lists and unpublished literature. Prospective cohort studies with ≥1-year follow-up, evaluating candidate physical prognostic factors [e.g. leg pain intensity and straight leg raise test], in adult patients undergoing lumbar discectomy/microdiscectomy were included. Two reviewers independently searched information sources, evaluated studies for inclusion, extracted data, and assessed risk of bias [QUIPS]. GRADE determined the overall quality of evidence. Results: 1189 title and abstracts and 45 full texts were assessed, to include 6 studies; 1 low and 5 high risk of bias. Meta-analysis was not possible [risk of bias, clinical heterogeneity]. A narrative synthesis was performed. There is low level evidence that higher severity of pre-operative leg pain predicts better Core Outcome Measures Index at 12 months and better post-operative leg pain at 2 and 7 years. There is very low level evidence that a lower pre-operative EQ-5D predicts better EQ-5D at 2 years. Low level evidence supports duration of leg pain pre-operatively not being associated with outcome, and very low-quality evidence supports other factors [pre-operative ODI, duration back pain, severity back pain, ipsilateral SLR and forward bend] not being associated with outcome [range of outcome measures used].Conclusion: An adequately powered low risk of bias prospective observational study is required to further investigate candidate physical prognostic factors owing to existing low/very-low level of evidence.

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Section: Discussioncontrasting

confidence: 72%

“…In comparison with other systematic reviews [13][14][15], this review included only prospective cohort studies which are the gold standard design for investigating prognostic factors to enable optimal measurement of outcomes and predictors [42]. Our findings illustrate that the current level of evidence is low/very low.…”

Section: Discussionmentioning

confidence: 86%

Physical prognostic factors predicting outcome following lumbar discectomy surgery: systematic review and narrative synthesis

Rushton

Zoulas²,

Powell³

et al. 2019

Physiotherapy

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“…Die Studien differenzieren meist nicht nach hochgradigen Einschränkungen (Paresen). Sicher scheint, dass die operative Therapie (in einem Kollektiv mit 40 % Paresen) der konservativen Therapie überlegen ist [28], eine Vermeidung langer Symptomatik (Tage bis Monate) scheint weitere Vorteile [29] hinsichtlich der funktionellen Wiederherstellung zu bieten. Eine aktuelle retrospektiv vergleichende Studie, die vor allem schwere motorische Defizite einschloss, konnte einen Vorteil der frühzeitigen Nukleotomie (< 48 h) nachweisen [30] (LoE 2b).…”

Section: Mechanisch Instabile Wirbelsäulenfrakturenunclassified

Scientific Backgrounds for the Timing of Acute Care Surgery

et al. 2019

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The correct timing of urgent surgery in the field of orthopedic and trauma surgery is under constant discussion. The authors of this review like to present a scientific based recommendation for the timing of acute care surgery using the TACS-classification for the description of urgency. The timing and priority of the indicated procedure is deduced only from the expected mortality and disability caused by a potential delay. A proposal for a nomenclature is given to be integrated in the clinical practice and to be completed.

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“…In their 2014 systematic review, Schoenfeld et al concluded that the duration of symptoms quite probably has an adverse effect on pain and functional recovery following lumbar discectomy, with a possible cutoff at 6 months following the onset of symptoms. 17 At the same time, Sabnis et al added that the time with symptomatology alone should not be the basis for a recommendation of surgery, given that there are other variables that negatively affect the outcome, such as social factors (long-standing medical leave, low educational level, single or divorced status), biological (more than 40 years of age) factors, etc. 18 Due to the inconsistent results in the available literature regarding a correlation between duration of symptoms and clinical outcome and to the absence of national studies of this type, we decided to evaluate patients who underwent lumbar discectomy at the Complejo Hospitalario San José (CHSJ).…”

Section: Introductionmentioning

confidence: 99%

Time Before Surgery vs Recovery of Lumbar Herniation. Chilean Reality in the Public Health System

Villagrán

López²,

Lorca

et al. 2019

Coluna/Columna

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Objective: To evaluate the influence between the time elapsed since the onset of symptoms and the surgery of lumbar HNP in the final functional recovery of the comprehensive treatment of patients. Methods: Retrospective descriptive study of cases of HNP treated by lumbar discectomy between 2009 and 2015 by the spine team of the Hospital San José, using SPSS (version 22 of IBM) for the statistical analysis. Results: Of 110 patients subject to surgery, 54 were recruited (22 women and 32 men), between 18 and 75 years old, with an average age of 43 years. Eighty percent of patients are active workers, 76% without comorbidities. The predominant level affected was L4/L5 with 52% of the cases. The mean progression time of the symptoms before the first consultation was 27 months, the waiting time between the consultation and the surgery was 5.6 months. Conclusions: Eighty-six percent of the patients -presented good results in VAS. The Oswestry questionnaire reached a positive result in 90%, a minimum disability in 40%, moderate in 50% and maximum in 10%. No statistical relationship was achieved between any of the evaluated variables and the outcome of the surgery. Level of Evidence IV; Therapeutic Study - Investigation of Treatment Results.

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Does Surgical Timing Influence Functional Recovery After Lumbar Discectomy? A Systematic Review

Cited by 41 publications

References 12 publications

Physical prognostic factors predicting outcome following lumbar discectomy surgery: systematic review and narrative synthesis

Physical prognostic factors predicting outcome following lumbar discectomy surgery: systematic review and narrative synthesis

Scientific Backgrounds for the Timing of Acute Care Surgery

Time Before Surgery vs Recovery of Lumbar Herniation. Chilean Reality in the Public Health System

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