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Nerve root retraction time during lumbar endoscopic discectomy: association with new onset radiculitis, a post-operative neurologic complication

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Abstract

Purpose

To evaluate the relationship between nerve root retraction time, post-operative radiculitis and patient reported outcomes.

Methods

Patients who underwent single- or multi-level lumbar discectomy between 2020 and 2022 for lumbar disk herniations were prospectively followed with pre-operative, interoperative and post-operative variables including radiculitis and patient reported outcomes including VAS, ODI and CAT domains Pain interference, Pain intensity and Physical function. Intraoperative nerve root retraction time was recorded. Paired sample two-tailed t-test and multivariate regression were utilized with p < 0.05 being significant.

Results

A total of 157 patients who underwent single- or multi-level endoscopic lumbar discectomy. Average patient age was 44 years, and 64% were male patients. Nerve retraction time ranged from 4 to 15 min. Eighteen percent reported new radiculitis at 2-weeks post-operatively. In patients with new-onset radiculitis 79.2% reported significantly worse VAS leg at 2 weeks post-operative (4.2 vs. 8.3, p < 0.001) compared to 12.5% who had improved VAS leg (9.3 vs. 7, p = 0.1181). Patients with radiculitis and worse VAS scores had substantially longer nerve retraction time (13.8 ± 7.5 min) than patients with improved VAS leg (6.7 ± 1.2 min). At 6 months, patients with longer nerve retraction time had no significant improvement in the ODI or CAT compared to the baseline.

Conclusions

This is the first study in discectomy literature to show that new onset radiculitis and poorer outcomes in VAS leg correlate with longer nerve retraction time at early and later time points.

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Authors and Affiliations

  1. Gerling Institute, Brooklyn, NY, USA

    Michael C. Gerling, Melissa Baker, Evan Chaladoff & Zorica Buser

  2. Department of Orthopedic Surgery, NYU Grossman School of Medicine, 94 9th Street, Unit 1-222, Brooklyn, NY, 11215, USA

    Michael C. Gerling & Zorica Buser

  3. Keck School of Medicine, University of Southern California, Los Angeles, USA

    Eloise Stanton

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  1. Michael C. Gerling
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Correspondence to Zorica Buser.

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Conflict of interest

No conflicts of interest for the current study. Disclosures outside of submitted work: MCG - Product Design/Royalties: Integrity Spine; Grants/ Research support: AO Spine (Paid directly to institution/employer); MiMedx (past, Paid directly to institution/employer), Nexus Spine (Paid directly to institution/employer), Medical Metrics (Paid directly to institution/employer); ZB – Grants/ Research support: AO Spine (Paid directly to institution/employer); Nexus Spine (Paid directly to institution/employer), Medical Metrics (Paid directly to institution/employer); MiMedx (past, Paid directly to institution/employer), SBIR NIH (past, Paid directly to institution/employer); Medical Metrics (past, Paid directly to institution/employer); Next Science (past, Paid directly to institution/employer); Consultancy: Next Science (paid directly to institution/employer); NIH (pending, advisor consultant); Scientific Advisory Board: Medtronic, Medical Metrics; Trips/Travel: AO Spine (Travel Expense Reimbursement, travel reimbursements for AO Spine Knowledge forum meetings and congresses), NASS (Travel Expense Reimbursement); Board of Directors: LSRS (Nonfinancial, Co-chair Program Committee); Committees: AO Spine Knowledge Forum Degenerative (Steering Committee Member); North American Spine Society: Research Project Management Committee (Vice chair), Section on Biologics & Basic Research (Co-chair), The Spine Journal Peer Reviewers (Committee member). Patents (issued): Biomarkers for painful intervertebral discs and methods of use thereof.

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Gerling, M.C., Baker, M., Stanton, E. et al. Nerve root retraction time during lumbar endoscopic discectomy: association with new onset radiculitis, a post-operative neurologic complication. Eur Spine J 33, 126–132 (2024). https://doi.org/10.1007/s00586-023-07952-6

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  • DOI: https://doi.org/10.1007/s00586-023-07952-6

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