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Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months.

Chris S Bailey1, Parham Rasoulinejad1, David Taylor1

  • 1From the Department of Surgery (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G., J.C.U.) and Occupational Health and Safety (R.R.), London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University (C.S.B., P.R., D.T., S.I.B., K.R.G., F.S., A.G.), Lawson Health Research Institute (C.S.B., P.R., J.C.U.), Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute (K.S.), and the Departments of Physical Medicine and Rehabilitation (T.M.) and Anesthesia and Perioperative Medicine (J.W.), St. Joseph's Hospital - all in London, ON, Canada.

The New England Journal of Medicine
|March 19, 2020
PubMed
Summary
This summary is machine-generated.

For chronic sciatica due to lumbar disc herniation, microdiskectomy surgery significantly reduced leg pain compared to conservative treatment after six months. This surgical approach offers better outcomes for persistent sciatica symptoms.

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Pain Management

Background:

  • Chronic sciatica resulting from lumbar disc herniation lacks extensive comparative treatment studies.
  • Evidence is needed to determine the efficacy of diskectomy versus conservative management for prolonged sciatica.
  • Lumbar disc herniation is a common cause of chronic sciatica, impacting quality of life.

Purpose of the Study:

  • To compare the effectiveness of microdiskectomy against nonoperative care for chronic sciatica.
  • To evaluate pain intensity and disability outcomes at various time points post-treatment.
  • To provide data for clinical decision-making in managing persistent sciatica.

Main Methods:

  • A single-center randomized trial assigned 128 patients with 4-12 month sciatica to microdiskectomy or 6-month nonoperative care.
  • The primary outcome was leg pain intensity measured by a visual analogue scale at 6 months.
  • Secondary outcomes included Oswestry Disability Index, back/leg pain, and quality of life at multiple follow-ups.

Main Results:

  • Microdiskectomy resulted in significantly lower leg pain scores (2.8) at 6 months compared to nonoperative care (5.2).
  • A substantial proportion (34%) of patients in the nonoperative group eventually opted for surgery.
  • Secondary outcomes favored the surgical group, with improved disability and pain scores.

Conclusions:

  • Microdiskectomy is superior to nonoperative care for patients with chronic sciatica caused by lumbar disc herniation.
  • The study demonstrates a clear benefit of surgical intervention for persistent leg pain.
  • Adverse events were minimal, with one case of repeat surgery for recurrence.