Jeffrey A. Rihn
Patients who undergo treatment for a herniated lumbar disc are less
likely to experience improvement in pain, function and satisfaction if they
wait more than 6 months before seeking treatment, according to a study from
researchers in Philadelphia.
The findings, published in the Journal of Bone and Joint
Surgery, observed 1,192 patients older than 18 years and enrolled in the
Spine Patient Outcomes Research Trial, conducted at 13 multidisciplinary spinal
practices in 11 states.
“Patients often ask their physicians whether the duration of their
symptoms will affect their potential for a full recovery, and the goal of our
study was to address this question,” study author Jeffrey A. Rihn, MD,
stated in an American Academy of Orthopaedic Surgeons press release.
“According to our study and generally speaking, patients who had symptoms
for more than 6 months had less improvement in pain, function, general health,
work status and patient satisfaction.”
The patients in the cohort received treatment for intervertebral lumbar
disc herniation. Rihn and his colleagues compared patients who had symptoms for
6 months or less (927 patients) to those who had symptoms for more than 6
months (265 patients). The primary and secondary outcomes for these patients
were measured at baseline and at regular follow-up intervals of 6 weeks, 3
months, 6 months, 1 year, 2 years and 4 years, the abstract noted.
Whether treatment was operative or nonoperative, Rihn’s team found
patients had significantly worse primary outcome measures if they experienced
symptoms for more than 6 months before treatment, as determined through an
analysis of multiple pain, function and disability indexes.
“Patients who have had symptoms for longer than 6 months can find
relief with either nonoperative treatment or surgery, but they may not reap as
much benefit as those who have had symptoms for 6 month or less,” Rihn
stated in the release. “Surgery still has significant benefit compared
with nonsurgical treatment, even in patients who have had symptoms for longer
than 6 months.”
- Rihn JA, Hilibrand AS, Radcliff K, et al. Duration of symptoms
resulting from lumbar disc herniation: Effect on treatment outcomes: Analysis
of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg
Am. 2011. doi:10.2106/JBJS.J.00878.
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