Introduction: Lumbar spinal stenosis and disc herniation are the most common spine pathologies requiring surgical intervention. A longer duration of symptoms may increase the risk of irreversible injury or other maladaptive changes that may influence outcome. We sought to determine if longer symptom duration in these conditions was associated with inferior surgical results.
Methods: The Canadian Spine Outcomes and Research Network (CSORN) registry was queried for all lumbar stenosis and disc herniation cases with neurogenic claudication or radiculopathy treated surgically. Spinal deformity and previous surgery were exclusion criteria. Cases were grouped based on symptom duration (<6 weeks, 6-12 weeks, 3-6 months, 6-12 months, 1-2 years, >2 years). The primary outcome was change in disability, as measured by Oswestry Disability Index (ODI). Secondary outcomes included leg pain numeric rating scale at 3, 12 and 24 months post-operatively as well as the ODI at 3 and 24 months post operatively.
Results: 830 stenosis and 551 disc herniation cases were included. Improvement in ODI was correlated with shorter symptom duration in stenosis patients at 3, 12 (primary outcome), and 24 months postoperatively, and in disc herniation cases at 3 and 24 months (p<0.05). Leg pain improvement also correlated with shorter duration of symptoms in lumbar stenosis at 3 and 12 months (p<0.05).
Preoperative ODI correlated inversely with symptom duration in both stenosis and disc herniation patients (p<0.005). All symptom duration groups had similar mean ODI and leg pain postoperatively in both the stenosis and herniation cohorts (p>0.1).
Conclusions: Lumbar stenosis patients with a shorter duration of symptoms had a greater improvement in their postoperative ODI. This was also observed in disc herniation cases 3 and 24 month follow-up. Patients with shorter symptom duration had greater preoperative disability. It is possible that this may have influenced the time to surgery. These patients had a correspondingly greater reduction in ODI upon surgical intervention but postoperative scores that were similar regardless of symptom duration. Operating on patients earlier within their disease course may result in a greater degree of clinical improvement.
Patient Care: We have demonstrated on a national multicenter scale that prolonged wait for surgical care in spine patients is associated with worse outcomes. This can help guide informed consent, surgical planning, and health care management.
Learning Objectives: How modifiable health system factors such as time to surgery can be associated with worse outcomes in spine surgery