title: Urgent discectomy: Clinical features and neurological outcome.
abstract: BACKGROUND
  To evaluate the clinical features and outcome of patients with progressive neurological deficits due to disc herniation who were treated surgically within 24 h.
  
  
  METHODS
  We conducted a retrospective analysis of consecutive patients who were admitted between 2004 and 2013 via the Emergency Department. Records were screened for presenting symptoms, neurological status at admission, discharge, and 6-week follow-up.
  
  
  RESULTS
  About 72 of 526 patients underwent surgery within 24 h. Magnetic resonance imaging showed lumbar disc herniation in 72 patients. The most common presenting symptoms included radiculopathy (n = 69), the Lasègue sign (n = 60), sensory deficits (n = 57), or motor deficits (n = 47). In addition, 11 patients experienced perineal numbness and 12 had bowel and bladder dysfunction. At discharge, motor and sensory deficits and bowel and bladder dysfunction had improved significantly (P < 0.001, P = 0.029, and P = 0.015, respectively).
  
  
  CONCLUSIONS
  Motor deficits, sensory deficits, and cauda equina dysfunction were significantly improved immediately after urgent surgery. After 6 weeks, motor and sensory deficits were also significantly improved compared to the neurological status at discharge. Thus, we advocate immediate surgery of disc herniation in patients with acute onset of motor deficits, perineal numbness, or bladder or bowel dysfunction indicative of cauda equina syndrome.
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Ruth
authors.initials: R
authors.lastname: Albert
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Lange
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Brawanski
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Karl-Michael
authors.initials: KM
authors.lastname: Schebesch
keywords: Disc herniation; outcome; radicular pain; urgent discectomy