PMID- 32252169
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2586-6583 (Print)
IS  - 2586-6591 (Electronic)
IS  - 2586-6591 (Linking)
VI  - 17
IP  - 1
DP  - 2020 Mar
TI  - Timing of Surgery in Tubular Microdiscectomy for Lumbar Disc Herniation and Its 
      Effect on Functional Impairment Outcomes.
PG  - 204-212
LID - 10.14245/ns.1938448.224 [doi]
AB  - OBJECTIVE: While it has been established that surgery for lumbar disc herniation, 
      excluding emergent indications, should only be performed after weeks of 
      conservative treatment, it has also been established that late surgery is 
      associated with poorer outscomes in terms of leg pain. However, nothing is known 
      concerning the timinig and functional outcome. We quantify the association of 
      time to surgery (TTS) with functional impairment outcome and identify a maximum 
      TTS cutoff. METHODS: A consecutive series of patients who underwent tubular 
      microdiscectomy for lumbar disc herniation was included. A reduction of >/= 30% in 
      the Oswestry Disability Index from baseline to 12 months was defined as the 
      minimum clinically important difference (MCID). TTS was defined as time of 
      symptom onset to surgery in weeks. The maximum TTS cutoffs were derived both 
      quantitatively by an area under the curve (AUC) analysis, as well as 
      qualitatively based on cutoff-specific MCID rates. RESULTS: Inclusion was met by 
      372 patients, among which 327 (87.9%) achieved MCID. MCID achievement was 
      associated with lower TTS (hazard ratio, 0.725; 95% confidence interval, 
      0.557-0.944; p = 0.014). The optimum maximum TTS based on AUC was 21.5 weeks. The 
      qualitative analysis showed a continuous drop of MCID rates with increasing TTS, 
      with values > 80% until week 14. CONCLUSION: Our findings suggest that longer TTS 
      is associated with a poorer patient-reported outcome in terms of functional 
      impairment, and that-depending on the calculation method and according to the 
      literature-a maximum TTS of between 14 to 22 weeks should likely be aimed for.
FAU - Siccoli, Alessandro
AU  - Siccoli A
AD  - Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.
FAU - Wispelaere, Marlies P de
AU  - Wispelaere MP
AD  - Department of Clinical Informatics, Bergman Clinics, Amsterdam, The Netherlands.
FAU - Schroder, Marc L
AU  - Schroder ML
AD  - Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.
FAU - Staartjes, Victor E
AU  - Staartjes VE
AD  - Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.
AD  - Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement 
      Sciences, Amsterdam, The Netherlands.
AD  - Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience 
      Centre, University of Zurich, Zurich, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20200331
PL  - Korea (South)
TA  - Neurospine
JT  - Neurospine
JID - 101724936
PMC - PMC7136121
OTO - NOTNLM
OT  - Discectomy
OT  - Early surgery
OT  - Functional impairment
OT  - Late surgery
OT  - Lumbar disc herniation
OT  - Surgical timing
COIS- The authors have nothing to disclose.
EDAT- 2020/04/07 06:00
MHDA- 2020/04/07 06:01
PMCR- 2020/03/01
CRDT- 2020/04/07 06:00
PHST- 2019/12/27 00:00 [received]
PHST- 2020/02/04 00:00 [accepted]
PHST- 2020/04/07 06:00 [entrez]
PHST- 2020/04/07 06:00 [pubmed]
PHST- 2020/04/07 06:01 [medline]
PHST- 2020/03/01 00:00 [pmc-release]
AID - ns.1938448.224 [pii]
AID - ns-1938448-224 [pii]
AID - 10.14245/ns.1938448.224 [doi]
PST - ppublish
SO  - Neurospine. 2020 Mar;17(1):204-212. doi: 10.14245/ns.1938448.224. Epub 2020 Mar 
      31.