PMID- 31653820
OWN - NLM
STAT- MEDLINE
DCOM- 20200630
LR  - 20200630
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 32
IP  - 2
DP  - 2019 Oct 25
TI  - Association of time to surgery with leg pain after lumbar discectomy: is delayed 
      surgery detrimental?
PG  - 160-167
LID - 2019.8.SPINE19613 [pii]
LID - 10.3171/2019.8.SPINE19613 [doi]
AB  - OBJECTIVE: While it has been established that lumbar discectomy should only be 
      performed after a certain waiting period unless neurological deficits are 
      present, little is known about the association of late surgery with outcome. 
      Using data from a prospective registry, the authors aimed to quantify the 
      association of time to surgery (TTS) with leg pain outcome after lumbar 
      discectomy and to identify a maximum TTS cutoff anchored to the minimum 
      clinically important difference (MCID). METHODS: TTS was defined as the time from 
      the onset of leg pain caused by radiculopathy to the time of surgery in weeks. 
      MCID was defined as a minimum 30% reduction in the numeric rating scale score for 
      leg pain from baseline to 12 months. A Cox proportional hazards model was 
      utilized to quantify the association of TTS with MCID. Maximum TTS cutoffs were 
      derived both quantitatively, anchored to the area under the curve (AUC), and 
      qualitatively, based on cutoff-specific MCID rates. RESULTS: From a prospective 
      registry, 372 patients who had undergone first-time tubular microdiscectomy were 
      identified; 308 of these patients (83%) obtained an MCID. Attaining an MCID was 
      associated with a shorter TTS (HR 0.718, 95% CI 0.546-0.945, p = 0.018). Effect 
      size was preserved after adjustment for potential confounders. The optimal 
      maximum TTS was estimated at 23.5 weeks based on the AUC, while the 
      cutoff-specific method suggested 24 weeks. Discectomy after this cutoff starts to 
      yield MCID rates under 80%. The 24-week cutoff also coincided with the time point 
      after which the specificity for MCID first drops below 50% and after which the 
      negative predictive value for nonattainment of MCID first surpasses >/= 20%. 
      CONCLUSIONS: The study findings suggest that late lumbar discectomy is linked 
      with poorer patient-reported outcomes and that-in accordance with the 
      literature-a maximum TTS of 6 months should be aimed for.
FAU - Siccoli, Alessandro
AU  - Siccoli A
AD  - 1Department of Neurosurgery, Bergman Clinics.
FAU - Staartjes, Victor E
AU  - Staartjes VE
AD  - 1Department of Neurosurgery, Bergman Clinics.
AD  - 2Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement 
      Sciences.
AD  - 3Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience 
      Centre, University of Zurich, Switzerland.
FAU - de Wispelaere, Marlies P
AU  - de Wispelaere MP
AD  - 4Department of Clinical Informatics, Bergman Clinics, Amsterdam, The Netherlands; 
      and.
FAU - Schroder, Marc L
AU  - Schroder ML
AD  - 1Department of Neurosurgery, Bergman Clinics.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
MH  - Aged
MH  - Back Pain/*surgery
MH  - *Diskectomy/adverse effects
MH  - Female
MH  - Humans
MH  - Intervertebral Disc Degeneration/surgery
MH  - Intervertebral Disc Displacement/*surgery
MH  - Lumbar Vertebrae/*surgery
MH  - Male
MH  - Operative Time
MH  - Patient Reported Outcome Measures
MH  - Radiculopathy/surgery
MH  - Registries
OTO - NOTNLM
OT  - ASA = American Society of Anesthesiologists
OT  - BMI = body mass index
OT  - LDH = lumbar disc herniation
OT  - MCID = minimum clinically important difference
OT  - NPV = negative predictive value
OT  - NRS = numeric rating scale
OT  - ODI = Oswestry Disability Index
OT  - PPV = positive predictive value
OT  - PROM = patient-reported outcome measure
OT  - TTS = time to surgery
OT  - discectomy
OT  - early surgery
OT  - late surgery
OT  - lumbar disc herniation
OT  - surgical timing
OT  - tMD = tubular microdiscectomy
OT  - time to surgery
EDAT- 2019/10/28 06:00
MHDA- 2020/07/01 06:00
CRDT- 2019/10/27 06:00
PHST- 2019/05/22 00:00 [received]
PHST- 2019/08/02 00:00 [accepted]
PHST- 2019/10/28 06:00 [pubmed]
PHST- 2020/07/01 06:00 [medline]
PHST- 2019/10/27 06:00 [entrez]
AID - 2019.8.SPINE19613 [pii]
AID - 10.3171/2019.8.SPINE19613 [doi]
PST - ppublish
SO  - J Neurosurg Spine. 2019 Oct 25;32(2):160-167. doi: 10.3171/2019.8.SPINE19613.