by Elizabeth Hofheinz, M.P.H., M.Ed.
In some situations, say the authors of a new retrospective cohort study, emergency surgery for lumbar disc herniation (LDH) may be performed due to “persistent or progressive motor paresis associated with radiculopathy or uncontrolled pain…Clinical outcomes and recurrence rates after lumbar discectomy have almost exclusively been studied in an elective setting, that is, among patients undergoing discectomy after unsuccessful nonoperative treatment.”
The researchers—from Finland—dove in to take a look at outcomes. Their work, “30-Day Recurrence, Readmission Rate, and Clinical Outcome After Emergency Lumbar Discectomy,” was published in the September 15, 2020 edition of Spine.
“Low back pain is one of the most common reasons to visit emergency department of acute care facility,” stated co-author Aleksi Reito, M.D., Ph.D. to OSN. “This topic is, however, highly understudied. There is some literature about the epidemiology and general aspects of patients with acute LBP, but literature about clinical outcomes is very scarce. Research is needed for patient guidance.”
First, the researchers examined data from all patients admitted to a hospital after an ED visit for acute low back pain who went on to undergo an emergency lumbar discectomy (during the 4-year study period). Individuals appearing in the ED who had a delayed discectomy comprised the control group.
Those performing surgery were categorized as a spinal surgeon or non-spinal surgeon. Patients’ occupational physical workload was one of the following: (1) light sedentary, (2) heavy sedentary, (3) light standing or mobile, (4) moderate bodily, (5) heavy bodily, and (6) very heavy bodily.
A total of 130 patients were admitted to the hospital after visiting the ED, having subsequent emergency discectomy a median of 1.0 days later. “Six patients in the study group [4.6%] had recurrent LDH and nine patients in total [6.9%] were readmitted within 30 days,” said the authors. “None of the baseline variables clearly predicted recurrence. Mean ODI [Oswestry Disability Index] difference between the study group and controls was 8.1. BMI and surgery by a non-spine surgeon were associated with higher ODI values.”
Dr. Reito: “The recurrence rate was surprisingly high considering that these patients improve usually very fast due to intense and uncontrollable pain. Also, the association between clinical outcome and surgeon experience can be considered somewhat surprising considering the clinical setting and sample size.”
“Patients referred to the ED with severe, radiating low back pain due to LDH may be different from those patients seen in less urgent setting such as in out-patient referrals. Although it depends on local resources and practice, emergency LDH may be sometimes required if no other options help the patient’s status or if muscle paresis mandates emergent surgery. Until further evidence, based on our results, patients should be informed that the risk of recurrent LDH is higher than usual after discectomy.”