Early versus delayed surgery for sciatica: A single-center observational study

Abstract

Lumbar discectomy can improve symptoms of sciatica caused by lumbar disc herniation (LDH) faster than conservative treatment. However, the optimal timing of surgery for LDH has scarcely been explored. The prospectively collected clinical outcome data from patients who underwent microdiscectomy for sciatica due to LDH were retrospectively analyzed. Patients were divided into 2 groups according to the duration of sciatica before surgery: early surgery (<6 months); and delayed surgery (≥6 months). Visual analog scale (VAS) scores for low back pain (LBP), leg pain (LP), and Oswestry disability index (ODI) were compared between the 2 groups preoperatively, and at 1, 3, 6, and 12 months postoperatively. In total, 122 and 115 patients comprised the early and delayed surgery groups, respectively. There were no significant differences between the 2 groups in terms of sex, age, body mass index, comorbidities, surgical procedure, surgical segment, preoperative LBP, LP VAS scores, or ODI. A significantly higher proportion of patients in the delayed surgery group were prescribed opioids preoperatively versus those in the early surgery group (25.2% vs 10.7%, respectively; P = .003). The duration of sciatica was significantly shorter in the early surgery group than that in the delayed surgery group (3.9 vs 12.2 months; P < .001). LBP VAS scores were significantly lower in the early versus delayed surgery group at 1 and 3 months postoperatively. Additionally, LP VAS scores and ODI in the early surgery group were significantly lower than those in the delayed surgery group at 1 month postoperatively. There was no significant difference in complication rates between the 2 groups (5.7% vs 5.2%; P = .860). Compared with delayed surgery, early surgery improved pain and disability in patients diagnosed with sciatica. However, this advantage tended to decline over time postoperatively, resulting in comparable long-term outcomes.

Keywords: lumbar disc herniation; microdiscectomy; sciatica; timing of surgery.

Figure 1.

The inclusion and exclusion flowchart of this study.

Figure 2.

(A) Comparison of LBP VAS scores between the 2 groups (^#P < .05). (B) Comparison of LP VAS scores between the 2 groups (^#P < .05). (C) Comparison of ODI between the 2 groups (^#P < .05). LBP = low back pain, LP = leg pain, ODI = Oswestry disability index, VAS = visual analog scale.