gms | German Medical Science

Objective: Lumbar disc surgery is widely practiced and is considered a safe procedure in general. The rate of complications has been low but variable in several studies. It was suggested, that the following factors could represent risk factors for complications: age of the patient, experience of the surgeon, reoperation for recurrent herniation and emergency surgery. Here we evaluated, whether complications rates indeed are higher in emergency operations as compared to elective surgery.

Method: Patient data sets from 498 microscopic lumbar disc surgeries were evaluated in a retrospective study design. Recurrent disc herniations were excluded. Age at surgery ranged between 22 and 96 years (mean age 56 years). A total number of 38 patients (7.6%) were operated as an emergency during the day or the night of admission (group N), whereas 460 patients (92.4) were operated electively (group E). The incidence of dural tears, the frequency of intra- and perioperative complications (wound infection, wound hematoma, nerve root injury), the rate of recurrent disc herniation, and the length of hospital stay were evaluated.

Results: There were no statically significant differences between the tow groups with regard to the incidence of dural tears (in group N 7.9%, in group E 4.3%, P= 0.32), the rate of complications (in group N 2.6%, in group E 2.8%, P=0.95), the rate of recurrent disc herniation (in group N 10.5%, in group E 8.9%, P=0.74) and the length of the hospital stay (P=0.35).

Conclusions: Emergency lumbar disc surgery has a similar safety profile like the elective surgery. Patients who present with cauda equina syndrome or progressive neurological deficits and need surgery on the day or the night of admission are not exposed to a higher risk of surgery.