Effects of Surgical Timing on the Prognosis of Far Lateral Disk Herniation

To evaluate the effects of surgical timing on the prognosis in far lateral disk herniations.

We retrospectively evaluated 171 patients diagnosed with far lateral disk herniation who underwent surgery between 2015 and 2021. Patients were divided into three groups: Those operated within the first 3 weeks, within 3-6 weeks, and after 6 weeks. Patients with progressive neurologic deficits and severe pain refractory to the analgesic treatment underwent surgery.

The mean age was 57±3 (28-85) years. The patients consisted of 96 females and 75 males. Sixty-eight patients underwent surgery at the L4-L5, 45 at the L3-L4, 37 at the L5-S1, and 21 at L2-3 levels. All patients had low back and radicular leg pain. Lasegue test was positive in 67% of patients. Femoral nerve stretch test was positive in 68%. Motor deficits, patellar reflex loss, and sensory deficits were present in 76%, 80%, and 91% respectively. When the postoperative recovery rates of patients who underwent surgery in all three time periods were compared according to visual analog scale, Oswestry disability index, and MacNab criteria, notably, statistically significant improvements in recovery were observed among patients who underwent surgery in the preoperative short time period when compared to those in the other time periods.

We believe that early surgery is important to prevent the progression of pain from acute to chronic neuropathic pain to promptly eliminate factors that activate the process and to provide faster and clearer symptom treatment.