PMID- 37038428
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230412
IS  - 2414-469X (Print)
IS  - 2414-4630 (Electronic)
IS  - 2414-4630 (Linking)
VI  - 9
IP  - 1
DP  - 2023 Mar 30
TI  - The importance of "time to surgery" in the management of lumbar disc herniation 
      in patients without progressive neurological deficits.
PG  - 32-38
LID - 10.21037/jss-22-68 [doi]
AB  - BACKGROUND: Prolonged sciatica symptoms may result in disability and 
      consequently, absence from work for a longer period. Up to 10% of patients may 
      need surgery but it is difficult to predict and determine which of these patients 
      would improve spontaneously in comparison to those who might benefit from 
      discectomy surgery. We aimed to determine if delay in the "time to surgery" (TTS) 
      has any adverse effects on the patient reported outcome measures (PROMs). 
      METHODS: Eighty-seven patients after exclusions were selected consecutively. 
      PROMs were comprised of pre-operative, six weeks and six months post-operative 
      back and leg pain visual analogue scores (VAS) and Oswestry disability index 
      (ODI). The differences between these scores were correlated with TTS. Minimal 
      clinically important difference (MCID) of 30% improvement for ODI scores and 33% 
      for VAS scores from baseline were considered as significant improvement. Patients 
      were grouped into TTS less than 6 months and TTS greater than 6 months from 
      referral to TTS. The longest TTS was 18 months. Statistical analysis was done 
      using JASP (Version 0.14.0) [computer software]. RESULTS: The TTS was on average 
      22.5 weeks. MCID for the leg pain VAS was achieved in 90.2% patients with TTS <6 
      months and in 80.8% with TTS >/=6 months. The MCID for ODI was achieved in 60.7% 
      with TTS <6 months and in 42.0% with TTS >/=6 months. The MCID for back pain VAS 
      was achieved in 73.8% with TTS <6 months and in 50.0% of patients with TTS >/=6 
      months. Those who achieved the MCID in ODI score between the two groups were 
      analysed using chi-square test with P=0.115. Those who achieved the MCID in VAS 
      leg pain score between the two groups were analysed using chi-square test with 
      P=0.227. No statistical difference was found in ODI and VAS for leg for patients 
      with TTS before or after 6 months. CONCLUSIONS: Lumbar discectomies had a 
      positive impact on patient's pain and function in our local district hospital. 
      Delayed surgery of >/=6 months did not cause statistically significant worse 
      outcomes. In the absence of worsening neurological deficit, it may be the wrong 
      approach to define a value for the TTS.
CI  - 2023 Journal of Spine Surgery. All rights reserved.
FAU - Gurung, Ishani
AU  - Gurung I
AD  - Department of Trauma and Orthopaedics, Royal Devon University Healthcare NHS 
      Foundation Trust, Raleigh Heights, Barnstaple, UK.
FAU - Jones, Matthew S
AU  - Jones MS
AD  - Department of Trauma and Orthopaedics, Royal Devon University Healthcare NHS 
      Foundation Trust, Raleigh Heights, Barnstaple, UK.
FAU - Jugurnauth, Paul
AU  - Jugurnauth P
AD  - Department of Trauma and Orthopaedics, Royal Devon University Healthcare NHS 
      Foundation Trust, Raleigh Heights, Barnstaple, UK.
FAU - Wafai, Ahmad M
AU  - Wafai AM
AD  - Department of Trauma and Orthopaedics, Royal Devon University Healthcare NHS 
      Foundation Trust, Raleigh Heights, Barnstaple, UK.
LA  - eng
PT  - Journal Article
DEP - 20230207
PL  - China
TA  - J Spine Surg
JT  - Journal of spine surgery (Hong Kong)
JID - 101685460
PMC - PMC10082427
OTO - NOTNLM
OT  - Disc herniation
OT  - lumbar discectomy
OT  - minimal clinically important difference (MCID)
OT  - time to surgery (TTS)
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://jss.amegroups.com/article/view/10.21037/jss-22-68/coif). The authors have 
      no conflicts of interest to declare.
EDAT- 2023/04/12 06:00
MHDA- 2023/04/12 06:01
PMCR- 2023/03/30
CRDT- 2023/04/11 01:44
PHST- 2022/07/22 00:00 [received]
PHST- 2022/11/21 00:00 [accepted]
PHST- 2023/04/12 06:01 [medline]
PHST- 2023/04/11 01:44 [entrez]
PHST- 2023/04/12 06:00 [pubmed]
PHST- 2023/03/30 00:00 [pmc-release]
AID - jss-09-01-32 [pii]
AID - 10.21037/jss-22-68 [doi]
PST - ppublish
SO  - J Spine Surg. 2023 Mar 30;9(1):32-38. doi: 10.21037/jss-22-68. Epub 2023 Feb 7.