Long Symptom Duration Linked to Poor Treatment Outcome for Lumbar Disc Herniation

Fran Lowry

March 18, 2010

March 18, 2010 (New Orleans, Louisiana) — Patients with lumbar disc herniation who wait more than 6 months before they seek treatment have worse outcomes after both operative and nonoperative procedures than patients who seek treatment earlier, researchers reported here at the American Association of Orthopaedic Surgeons 2010 Annual Meeting.

"Lumbar disc herniation, or slipped disc, mainly affects adults aged 30 to 40 years. The most common cause is degenerative changes in the spine," said lead investigator Jeffrey Rihn, MD, assistant professor at Thomas Jefferson University Rothman Institute in Philadelphia, Pennsylvania.

The symptoms can come on gradually, starting with pain in the lower back. As the condition progresses, patients can suffer from extreme back pain that can also spread into the buttocks and down the legs.

Dr. Rihn and colleagues studied the effect of symptom duration when treating herniated discs in the lower back.

They analyzed patients enrolled in the National Institutes of Health–sponsored Spine Patient Outcomes Research Trial (SPORT), a comprehensive study of the surgical and nonsurgical treatment of intervertebral lumbar disc herniation, comparing outcomes between patients with less than 6 months (n = 927) and those with more than 6 months (n = 265) of pretreatment symptom duration.

The patients were assessed at regular intervals for up to 4 years.

The study found that outcomes were significantly worse in patients with a symptom duration of more than 6 months at each assessment period. This was true for both operative and nonoperative treatment.

The investigators used the SF-36 questionnaire, a self-reported questionnaire consisting of 36 questions that assess the patient's physical function.

At 4 years, the change in the SF-36 physical function score from baseline in the operative group was 47.7 in patients whose symptoms lasted less than 6 months, and was 41.2 in patients whose symptoms lasted more than 6 months (P < .001).

In the nonoperative group, changes in SF-36 physical function score from baseline was 29.5 for patients with a symptom duration of less than 6 months, and 22.6 for patients with a symptom duration of more than 6 months (P = .015).

"This study is important because it answers a question that patients often have, which is, will they have the same outcome even though they have been having symptoms for a long time," Dr. Rihn told Medscape Orthopaedics. "It is important in the clinical setting because the results can be used when counseling patients with symptomatic lumbar disc herniation."

He added that he and his team were surprised that the results clearly showed that patients with a longer symptom duration do not do as well as patients with a shorter symptom duration.

Commenting on this study, moderator Paul Saiz, MD, from Las Cruces Orthopaedic Associates in New Mexico, agreed that the study was important because it provides data that will allow physicians to make decisions "based on evidence."

"I think this is a landmark study that is going to be used in the future to guide decision making, not only on the part of physicians, but also by government," he added.

Dr. Rihn has disclosed no relevant financial relationships. Dr. Saiz reports financial relationships with Zimmer.

American Association of Orthopaedic Surgeons (AAOS) 2010 Annual Meeting: Abstract 061. Presented March 10, 2010.

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