The Timing of Diskectomy as a Predictor of Outcomes in Patients With Lumbar Disk Herniation

Neurosurgery 98:1051–1062, 2026

This prospective cohort study evaluates how the duration of preoperative symptoms influences outcomes after microdiskectomy for lumbar disk herniation. Outcomes measured include radicular pain, low back pain, disability (ODI), and motor and sensory deficits, with follow-up at 6 weeks, 6, 12, and 24 months in 1,120 analyzed patients.

Key finding: surgical intervention within one month of symptom onset yields faster, more pronounced pain relief and neurological recovery, whereas symptoms persisting beyond two years associate with the highest rates of residual motor and sensory deficits at 24 months.

Objective Evaluate how the preoperative duration of low back pain, disability, radicular leg pain, and motor/sensory deficits relates to postoperative outcomes after microdiskectomy for lumbar disk herniation (LDH).

Design/setting Prospective cohort (April 2015–October 2022) of adults undergoing microdiskectomy for symptomatic LDH with imaging-confirmed herniation consistent with symptoms.

Assessments & follow-up Pain measured by NRS, disability by ODI, motor deficit by MRC grading, sensory deficit as present/absent; assessed pre-op and at 6 weeks, 6, 12, and 24 months post-op.

Cohort size 1222 patients enrolled; 69 recurrences and 33 lost to follow-up excluded, leaving 1120 for statistical analyses.

Symptom-duration grouping Patients categorized by symptom duration thresholds ≤1, ≤6, ≤24, and ≥25 months for LDH-related symptoms (pain/disability/neurologic symptomatology).

Key outcome (timing) Surgery performed within 1 month of symptom onset was associated with more favorable outcomes than longer symptom duration, including faster improvement in neurological deficit and more significant radicular pain relief.

Residual deficits at 2 years Residual motor and sensory deficits at 24 months were least common when preoperative neurological symptoms lasted ≤1 month, and more common when symptoms exceeded 1 month.

Worst outcomes with long duration LDH symptoms persisting beyond 2 years were associated with the least favorable postoperative outcomes, including the highest residual motor and sensory deficits at 2 years.