title: Comparison of early and late percutaneous endoscopic lumbar discectomy for lumbar disc herniation.
abstract: BACKGROUND
  The optimal timing for percutaneous endoscopic lumbar discectomy (PELD) in cases of lumbar disc herniation (LDH) is debatable. This retrospective study sought to determine which category of PELD surgical intervention time resulted in greater improvement in clinical outcomes.
  
  
  METHODS
  We retrospectively reviewed the medical records of 145 patients who underwent PELD for single-level LDH. The patients were divided into three categories according to the duration of leg pain before surgery, the early and late group being symptomatic for ≤3 months and >3 months, ≤6 months and >6 months, ≤12 months and >12 months. Surgical time, blood loss, postoperative hospital stay, hospitalization cost, rates of reoperation due to surgical failure, Macnab criteria assessment, visual analogue scale (VAS) of back pain, leg pain and numbness, Japanese orthopedic association low back pain score (JOA) before and after surgery were compared.
  
  
  RESULTS
  No significant differences were found between the early and late groups according to different categories in patients' demographics, surgical time, blood loss, preoperative and postoperative VAS (lower-back pain, leg pain and numbness) scores, JOA scores and distribution of Macnab criteria assessment. Early PELD surgical intervention did not result in greater improvement of clinical outcomes. Later surgical intervention resulted in about one-third surgical failure rates for patients being symptomatic for >6 months (≤6 months, 11/96, 11.5 %; >6 months, 2/49, 4.1 %; P = 0.245) and >12 months (≤12 months, 12/120, 10.0 %; >12 months, 1/25, 4.0 %; P = 0.568) of the early surgical intervention groups. Significant difference was observed between the comorbidities and non-comorbidities group in the rate of reoperation (P = 0.040).
  
  
  CONCLUSIONS
  Early PELD surgical intervention did not result in greater improvement of clinical outcomes for patients with lumbar disc herniation. Later surgical intervention resulted in less failure rates for patients than the early surgical intervention groups. PELD performed when the leg pain before surgery being symptomatic for >6 months may be good for avoiding surgical failure and reducing the duration of leg pain.
authors: Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning, 110016 , China.
authors: Hongwei
authors: H
authors: Wang
authors: Bo
authors: B
authors: Huang
authors: Wenjie
authors: W
authors: Zheng
authors: Changqing
authors: C
authors: Li
authors: Zhengfeng
authors: Z
authors: Zhang
authors: Jian
authors: J
authors: Wang
authors: Yue
authors: Y
authors: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017587:Diskectomy, Percutaneous / Q000379:methods*; D018479:Early Intervention, Educational; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D017116:Low Back Pain / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult