Microdiscectomy compared with transforaminal epidural steroid injection for persistent radicular pain caused by...

Area of Science:

• Spinal surgery and pain management
• Health economics and outcomes research
• Clinical trial methodology

Background:

• Sciatica, often caused by a prolapsed intervertebral disc, affects over 3% of the UK population.
• Current treatment strategies for sciatica lack uniformity.
• Invasive treatments like microdiscectomy and epidural steroid injections are typically reserved for cases unresponsive to conservative care.

Purpose of the Study:

• To compare the clinical and cost-effectiveness of microdiscectomy versus transforaminal epidural steroid injection for sciatica.
• To evaluate treatments for radicular pain due to lumbar disc prolapse with less than 12 months' duration.

Main Methods:

• A pragmatic, multicentre, randomised prospective trial involving 163 participants aged 16-65.
• Participants were randomised to either microdiscectomy or transforaminal epidural steroid injection.
• Primary outcome: Oswestry Disability Questionnaire score at 18 weeks; secondary outcomes included pain scores and quality of life measures.

Main Results:

• No statistically significant difference in effectiveness was found between microdiscectomy and transforaminal epidural steroid injection at 18 weeks.
• Microdiscectomy had a higher rate of serious adverse events (3.8%) compared to steroid injections (0%).
• Microdiscectomy was not found to be cost-effective at a threshold of £20,000 per quality-adjusted life-year.

Conclusions:

• Microdiscectomy and transforaminal epidural steroid injection demonstrate comparable clinical effectiveness for sciatica.
• Transforaminal epidural steroid injection appears to be a more cost-effective option than microdiscectomy for sciatica management.
• Further research may inform earlier and more streamlined management of discogenic sciatica.