For patients with herniated lumbar disc, outcomes were substantially worse if patients experienced symptoms for over six months before treatment, compared with those whose symptoms appeared less than half a year before treatment, according to a new study.

Researchers at Thomas Jefferson University Hospital (Philadelphia, PA, USA) conducted an as-treated analysis of 1,192 patients aged 18 years or older enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of intervertebral lumbar disc herniation; both randomized and observational cohorts were combined. A comparison was made between patients who had had symptoms for six months or less (927 patients) and those who had had symptoms for more than six months (265 patients). The treatment effect for each outcome measure was determined at regular follow-up intervals of up to four years for the duration of symptoms for both groups.

The results showed that patients in the operative treatment group who had had symptoms for six months or less had a greater increase in the bodily pain domain and the physical function domain of the SF-36, and a greater decrease in the Oswestry Disability Index score as compared with those who had had symptoms for more than six months. When the values at the time of the four-year follow-up were compared with the baseline values, similar results were obtained. Operative therapy was also substantially more effective compared with nonoperative treatment, but the relative increased benefit of surgery over nonoperative treatment was not dependent on the duration of symptoms. The study was published in the October 19, 2011, issue of the Journal of Bone and Joint Surgery.

“Surgery still has significant benefit compared with nonsurgical treatment, even in patients who have had symptoms for longer than six months,” said lead author orthopedic surgeon Jeffrey Rihn, MD, “But according to our study and generally speaking, patients who had symptoms for more than six months had less improvement in pain, function, general health, work status, and patient satisfaction.”

A lumbar disc herniation is a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc that allows part of, or the entire, soft central portion to be forced out from between two vertebrae, causing back pain, and can also push on nerve roots causing pain, numbness and tingling as well as weakness in one or both legs. Symptomatic lumbar disc herniation affects 1%-2% of the population at some point in their lives, usually between 30-40 years of age, and is one of the most common and debilitating conditions of the spine.

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