Effect of Duration of Symptoms on the Clinical and Functional Outcomes of Lumbar Microdiscectomy: A Randomized Controlled Trial

Abstract

Background Microdiscectomy is the gold standard surgical procedure for symptomatic lumbar disc herniation. The aim of this study is to determine whether the preoperative duration of symptoms can affect the postoperative clinical and functional outcomes after microdiscectomy for symptomatic lumbar disc herniation. Method A single blind, randomized controlled trial was performed by single spine surgeon on patients with symptomatic lumbar disc herniation. 122 patients, who had eligibility criteria, were divided randomly by computer system into 3 groups (A, B and C) who were operated at six weeks, three months and six months from the onset of symptoms respectively. 97 patients were analyzed at the end of this study for outcome measures. Primary outcome measures are Oswestry disability index, Roland-Morris Questionnaire and Visual analogue scale for back pain and leg pain. Secondary outcome measures are post-operative complications, length of hospital stay and time of return to daily activities.Results Better results among study’s groups were in sequence of group A, group B then group C. There was significant difference in Oswestry disability index score until three years of follow up (P-value <0.001). Improvement in Roland-Morris Questionnaire among the groups was significant at three months post-operatively (P-value <0.001). Visual analogue scale for back pain was better significantly at 2 weeks post-operatively (P-value=0.002) while Visual analogue scale for leg pain was better significantly at 3 months postoperatively (P-value=0.003). There was no significant difference among study’s groups regarding other outcome measures.Conclusion Preoperative duration of symptoms in patients with lumbar disc herniation can affect the clinical and functional outcomes after microdiscectomy. The shorter duration of symptoms the better postoperative outcomes are. This effect of duration of symptoms on postoperative outcomes is more significant in early postoperative period.Trial registration NCT, NCT04538027. Registered 1 September 2020 -Retrospectively registered, https://www.clinicaltrials.gov/NCT04538027