Management of lumbar disc herniation with radiculopathy: Results of an Iberian-Latin American survey
- Department of Orthopedics, Hospital Regional de Talca, Talca, Region del Maule, Chile
- Associate Professor, Universidad Católica del Maule, Talca, Chile
- Department of Orthopedics, Clinica Alemana, Santiago, Chile,
- Department of Orthopaedic Surgery and Traumatology, UHC Santiago de Compostela, Praza do Obradoiro, Santiago de Compostela, La Coruña, Spain,
- Department of Orthopedics, Hospital Universitario Evangélico Mackenzie de Curitiba, Curitiba, Brazil.
Guisela Quinteros, Associate Professor, Department of Orthopedics, Hospital Regional de Talca, Talca, Region del Maule, Chile, Universidad Católica del Maule, Talca, Chile.
DOI:10.25259/SNI_262_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Guisela Quinteros1,2, Ratko Yurac3, Juan José Zamorano3, Máximo-Alberto Díez-Ulloa4, Edson Pudles5, Bartolomé A. Marré3. Management of lumbar disc herniation with radiculopathy: Results of an Iberian-Latin American survey. 19-Jul-2021;12:363
How to cite this URL: Guisela Quinteros1,2, Ratko Yurac3, Juan José Zamorano3, Máximo-Alberto Díez-Ulloa4, Edson Pudles5, Bartolomé A. Marré3. Management of lumbar disc herniation with radiculopathy: Results of an Iberian-Latin American survey. 19-Jul-2021;12:363. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=10975
Background: Lumbar disc herniation (LDH)/radiculopathy is the most frequent cause of lost workdays in people under 50 years of age. Although there is consensus about how to assess these patients, the optimal management strategy is still debated.
Methods: An online survey was sent to spine surgeons who are members of the Iberian-Latin American Spine Society to assess how they treat LDH with radiculopathy.
Results: There were 718 surgeons who answered the survey; 66% reported that 76–100% of their monthly clinic work was due to spine issues. The most frequently used conservative treatment modalities included non-opioid analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) (90.5%), followed by physical therapy (55.2%) and pregabalin (41.4%). Notably, 40% of surgeons in the public sector believed that conservative treatment failed if symptoms persisted beyond 6–12 weeks, while 39% of private surgeons deemed conservative management insufficient if it had failed to provide symptomatic relief with 3–6 weeks. Of interest, 78% utilized epidural steroid injections (ESI); 51.7% preferred the transforaminal, 27.2% the interlaminar, and 7.5% the caudal approaches. The most frequent indications for surgery included: cauda equina syndrome, progressive neurological deficits, and intractable pain. Traditional microdiscectomy was the most common technique (68.5%) utilized, followed by 7.5% advocating endoscopic disc resection, and just 6.4% favoring the tubular discectomy.
Conclusion: There is considerable heterogeneity among Iberian and Latin American spine surgeons in the treatment of LDH/radiculopathy. Although most begin with the utilization of NSAIDs and non-opioid analgesics, followed by ESI (88%), surgery was recommended for persistent symptoms/signs for those failing between 3 and 6 weeks (private sector) versus 6–12 weeks (public sector) of conservative therapy.
Keywords: Disc herniation, Discectomy, Injection, Radiculopathy
There is a 5% prevalence of radicular pain due to LDH that it mainly affects patients between 30 and 50 years of age.[
We utilized a 5–10 min/14 point SurveyMonkey® questionnaire [
General overview of participants
A total of 718 spine surgeons answered our survey; 163 (22.70%) neurosurgeons and 555 (77.3%) orthopedic surgeons [
Initial conservative management
NSAIDs and non-opioid analgesics were prescribed by 90.5% (n = 650) of all spinal surgeons. Additional recommendations included: physical therapy (55%), pregabalin (41.4%), and opioids (15.3% and tricyclic antidepressants (4.2%); [
Duration of persistent symptoms impacted treatment failure
Notably, 40% of surgeons in the public sector believed that conservative treatment failed if symptoms persisted beyond 6–12 weeks, while 39% of private surgeons deemed conservative management insufficient if it had failed to provide symptomatic relief with 3–6 weeks.
Epidural Steroid injections (ESI)
ESI were utilized in 50.8% of patients not responding to other first-line treatments. The most frequent approach was transforaminal (51.7%), followed by an interlaminar (27.2%) and caudal approach (7.5%). Notably, other studies acknowledge that ESI have no documented long-term efficacy.[
The indications for surgery included progressive neurological deficits (87.3%), intractable pain (86.2%), cauda equina syndromes (78.4%), a motor deficits worse than 3/5 (34.5%), and isolated sensory deficits (14.4%). Traditional microdiscectomy was the most commonly preferred technique (68.5%), followed by 7.5% endoscopic discectomy and finally 6.4% using the tubular discectomy [
This survey provides an overview of the preferred conservative and surgical treatments for LDH with radiculopathy among surgeons practicing on the Iberian Peninsula or in Latin America.
NSAIDs and non-opioid analgesics and physical therapy were most frequently used as first-line treatment.[
Time to failure of conservative management
Thirty-nine percent of our surveyed surgeons considered that conservative treatment failed after just 3–6 weeks of treatment, while 40% did so after 6–12 weeks, with a tendency toward shorter wait times before surgery in the private versus public system.
Indications for spine surgery
In our survey, there were no significant differences in surgical indications for spine surgeons practicing in private versus public health systems. (i.e. progressive neurological impairment (87.3%), intractable pain 86.2%, cauda equina syndromes (78.4%), motor deficits of M3/5 or less (34.5%), and isolated sensory deficits (14.4%).
Notably, the vast majority of spine surgeons preferred conventional open microdiscectomy (68.5%) to minimally invasive endoscopic or tubular techniques.
This survey documented significant variability among Iberian and Latin American spine surgeons’ practices for the treatment of LDH with radiculopathy.
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