Timing is crucial in the treatment of patients with severe motor deficits caused by lumbar disc herniation
EANS Academy. Koegl N. 09/27/19; 276075; EP02074
Dr. Nikolaus Koegl
Dr. Nikolaus Koegl

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Background Information: Patients with intervertebral disc herniation undergo surgical removal of herniated disc material in case of persisting symptoms or neurologic deficits. While motor deficits often prompt surgery, only little is known about the optimal timing of surgery in these cases. In cauda equina syndrome urgent surgery within 48 hours has been advocated. A recently published retrospective study has also indicated superior outcome for early surgery (< 48 hours) in patients with severe motor deficits.
Aims and objectives: The aim of this single-centre study was therefore to prospectively evaluate the impact of timing in this common intervention.
Materials and methods: 120 patients who underwent microsurgical limited discectomy between 09/2015 and 12/2015 were included. In 61 patients motor deficits (MRC 0-4) were present at the time of admission. Patient demographics, neurologic deficits, duration of motor deficits, treatment characteristics, and outcome measurements were collected prospectively. At a minimum follow-up of 1 year functional recovery, complications and the need for revision surgery were assessed. Patients were subdivided into groups according to the severity of the paresis (MRC ≤3/5 vs. MRC 4/5). Groups were matched based on the duration of the neurologic deficits, as postponing surgical treatment may worsen the outcome.
Results: Patients with more severe paresis (MRC ≤3/5) benefit from treatment within 48hours as they showed significantly higher complete recovery rates at 1-year follow-up (77.8% vs. 12.5%; p=0.002).
Conclusions: Immediate surgery should be offered to patients with severe motor deficits to increase the likelihood of neurological recovery.
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