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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2206-2718
Original Article

COVID-19 and Spontaneous Resolution of Lumbar Disk Prolapse: A Retrospective Cohort Study of Patients Awaiting Microdiscectomy

Dana Hutton 
1   Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
2   Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Belal Mohamed
1   Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Khalid Mehmood
1   Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
,
James Magro
1   Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Himanshu Shekhar
1   Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Anna Solth
1   Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Heinke Pulhorn
1   Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
,
David Bennett
1   Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Mohamed Okasha 
1   Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations Funding None.
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Abstract

Background Between individual patients with lumbar disk prolapse (LDP), the natural course of disease is significantly variable. Spontaneous resolution is reported to occur in up to 70% of cases. However, we currently cannot predict for whom and when this will occur. Neurosurgical intervention is indicated for LDP patients with nontolerable pain after at least 8 to 12 weeks of conservative management, or significant neurologic deficit. Channeling essential resources in the National Health Service (NHS) to fight the COVID-19 pandemic led to the postponement of most elective operations, including microdiskectomy. This left many LDP patients previously considered to be surgical candidates with conservative-only options in the interim. To our knowledge, we are the first center to report the specific impact of the peri- and postpandemic period on waiting list times, delayed elective microdiskectomy, and the incidence of spontaneous LDP resolution.

Methods Retrospective case series of a prospectively collected electronic departmental database identified LDP patients who would have been impacted by the COVID-19 pandemic at some point in their care pathway (March 2020–February 2022). Further information was obtained from electronic patient records.

Results In total, 139 LDP patients were listed for elective microdiskectomy at the time of postponement of elective surgery. Over a third of LDP patients (n = 47, 33.8%), in shared decision with the responsible neurosurgeon, had their rescheduled microdiskectomy canceled due to clinical improvement (14.1%), radiologic regression (6.5%), or both (12.2%).

Conclusion Our single-center retrospective analysis revealed that for over a third of LDP patients, the prolonged postpandemic waiting list times for elective microdiskectomy resulted in their surgery not taking place either due to spontaneous clinical improvement or proven radiologic regression. Considering this, a prolonged conservative approach to LDP may be appropriate in some patients, allowing time for natural resolution, while avoiding perioperative risks.

Keywords

spontaneous resolution - disk prolapse - microdiskectomy - coronavirus-19 - pandemic

Author Contributions

D.H. and M.O. were responsible for conception and design of the study. Acquisition of data was done by M.O., D.H., B.M., K.M., J.M., and H.S. Analysis and interpretation of data and drafting of the article were done by D.H. and M.O. Critical revision of the article was done by M.O., H.P., D.B., and A.S. Review of the submitted version of the manuscript was done by M.O. and D.H. M.O. approved the final version of the manuscript on behalf of all the authors.




Publication History

Received: 23 September 2023

Accepted: 06 November 2023

Accepted Manuscript online:
08 November 2023

Article published online:
24 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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