Late results of surgery for herniated lumbar disk as related to duration of preoperative symptoms and type of herniation

Background: Ten to 40% of patients who have undergone state-of-the-art surgery for HLD do not obtain relief of pain. The relationship among timing of surgery for HLD, type of herniation, and clinical outcome, questioned in the present study, has rarely been referred to as an individual medical factor. Methods: Sixty-three patients belonging to a single ethnic group were called in 2 to 5 years after surgery and scored for change in severity of HLD-related pain (VAS) and current disability as scored by a functional rating system (Spangfort). Results: Patients with noncontained herniation (group 1), as compared with those with contained herniation (group 2), had had more intense radicular pain preoperatively (mean VAS, 8.3 vs 6.5), had a shorter history of pain (mean, 7.4 vs 15.8 weeks), and enjoyed a better functional outcome (good or fair in 96.4% vs 74.3%). Those in group 1 with a preoperative pain history of 6 weeks or less showed a greater decrease in pain intensity than those with a pain history of 6 to 12 weeks. Group 2 patients had had a longer preoperative history of symptoms than any in group 1 (>12 weeks in all) and showed an intermediate decrease in pain intensity. Conclusions: Patients with noncontained herniation who do not show signs of improvement should be offered elective surgery after 6 to 8 weeks of observation; those having contained herniation should be advised that a certain degree of benefit can be expected from surgery, however late.