Malmivaara A, Osterman H, Seitsalo S, Karppinen J; Health Technology Assessment International. Meeting (1st : 2004 : Krakow, Poland).
Proc One HTA Health Technol Assess Int Meet 1st 2004 Krakow Pol. 2004; 1: 294.
FinOHTA, Helsinki, Finland.
OBJECTIVES: Only one randomized trial has compared lumbar discectomy with conservative treatment, but the recruitment took place in the early 70's and the treatment methods and outcome measures are, by now, outdated. We aimed to assess the effectiveness of modern lumbar microdiscectomy in comparison with conservative treatment among patients with sciatica due to a herniated disc. METHODS: Fifty-six patients with radicular pain of 6 to 12 weeks' duration and a radiologically verified lumbar disc herniation were randomized. Every patient had clinical findings of nerve root compression but no absolute indication for operation. The patients were followed until two years with leg pain intensity as the primary outcome measure. Secondary outcomes included back pain, subjective disability, perceived work ability, generic health-related quality of life, and satisfaction with treatment. RESULTS: The surgical patients reported faster resolution of symptoms and better treatment satisfaction. The repeated measures analysis, however, showed no differences between the groups in leg or back pain intensity, subjective disability, work ability, or health-related quality of life over the two-year follow-up. In subgroup analyses, operative treatment was associated with a good outcome when the disc herniation was located between fourth and fifth lumbar vertebra. DISCUSSION: Microdiscectomy patients were highly satisfied with their treatment and reported a more expeditious recovery than control group patients. During the entire two-year follow-up, however, there were no clinically or statistically significant differences in any other of the outcome measures between the two groups. The findings in the subgroup analyses are clinically plausible.
Publication Types:
Keywords:
- Back Pain
- Diskectomy
- Hernia
- Humans
- Intervertebral Disk Displacement
- Leg
- Lumbar Vertebrae
- Pain
- Pain Measurement
- Radiculopathy
- Research Design
- Sacrum
- Sciatica
- surgery
- hsrmtgs
UI: 103140923
From Meeting Abstracts