title: Does the duration of symptoms influence outcome in patients with sciatica undergoing micro-discectomy and decompressions?
abstract: BACKGROUND
  Early surgical treatment for back and leg pain secondary to disc herniation has been associated with very good outcomes. However, there are conflicting data on the role of surgical treatment in case of prolonged radicular symptomatology.
  
  
  OBJECTIVE
  We aimed to evaluate whether the duration of symptoms at presentation affects the subjective outcome.
  
  
  METHODS
  This is a retrospective review of prospectively collected data from a single surgeon including micro-discectomies and lateral recess decompressions in patients younger than 60 years old using patient medical notes, radiology imaging, operation notes, and Patient Reported Outcome Measures (PROMS) including Oswestry Disability Index (ODI), visual analogue scale for back pain and leg pain (VAS-BP and VAS-LP). The final follow-up was carried out through postal questionnaire or telephone consultation.
  
  
  METHODS
  Demographic information, duration of symptoms, type and incidence of complications, length of hospital stay, and follow-up were analyzed. Data were categorized into four subgroups: symptoms 0≥6 months, 6 months≥1 year, 1 year≥2 years, and >2 years. A clinically significant result was an average improvement of 2 or more points in the VAS and of 20% and over in the ODI. The level of statistical significance was <0.05%.
  
  
  RESULTS
  A total number of 107 patients who underwent 109 operations were included. The level of surgery was L5/S1 (50), L4/L5 (43), L3/L4 (3), L2/L3 (2), and two levels (11). The mean improvement was from 0 to ≤6 months (VAS-LP 5.21±2.81, VAS-BP 3.04±3.15, ODI 35.26±19.25), 6 months to ≤1 year (VAS-LP 4.73±2.61, VAS-BP 3.30±3.05, ODI 26.92±19.49), 1 year to ≤2 years (VAS-LP 3.78±3.68, VAS-BP 3.00±2.78, ODI 19.03±20.24), and >2 years (VAS-LP 4.77±3.61, VAS-BP 3.54±3.43, ODI 28.36±20.93). The length of hospital stay and complication rate was comparable between groups. Average follow-up was 15.69 months.
  
  
  CONCLUSIONS
  Our study showed significant improvement in patients with symptoms beyond 1 as well as 2 years since onset, and surgery is a viable option in selected patients.
authors.affiliation: Plymouth Spine Services, South West Neurosurgical Department, Derriford Hospital, Derriford Rd, Plymouth, Devon PL6 8DH, United Kingdom. Electronic address: marinapitsi@hotmail.com.
authors.forename: Marina
authors.initials: M
authors.lastname: Pitsika
authors.affiliation: Plymouth Spine Services, South West Neurosurgical Department, Derriford Hospital, Derriford Rd, Plymouth, Devon PL6 8DH, United Kingdom.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Thomas
authors.affiliation: Plymouth Spine Services, South West Neurosurgical Department, Derriford Hospital, Derriford Rd, Plymouth, Devon PL6 8DH, United Kingdom.
authors.forename: Sabeena
authors.initials: S
authors.lastname: Shaheen
authors.affiliation: Plymouth Spine Services, South West Neurosurgical Department, Derriford Hospital, Derriford Rd, Plymouth, Devon PL6 8DH, United Kingdom.
authors.forename: Himanshu
authors.initials: H
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000009:adverse effects; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000503:physiopathology* / Q000601:surgery*; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D012585:Sciatica / Q000209:etiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Back pain; Duration of symptoms; Microdiscectomy; Outcome; Sciatica; Surgery