Effectiveness of Sciatica Treatment, Herniated Disc Surgeries Compared in Recent Study

Effectiveness of Sciatica Treatment, Herniated Disc Surgeries Compared in Recent Study

Examining the effectiveness of conventional microdiscectomy and tubular disectomy surgeries for treatment of sciatica symptoms resulting from a herniated disc, a recent study found and opined that the minimally invasive, tubular surgery did not result in better outcomes for patients despite such claims in the past.

The Sciatica Micro-Endoscopic Diskectomy randomized controlled trial was conducted with the goal of determining patient outcomes and recovery times for the following surgeries treating leg pain symptomatic of sciatica from herniated discs:

  • conventional microdiscectomy. The most commonly performed surgery for patients with sciatic leg pain from disc herniation, microdiscectomy (also known as lumbar decompression surgery) entails the removal of a small portion of the bone over the nerve root and/or disc material under the nerve root to relieve neural impingement and provide more room to heal.
  • tubular discectomy. Introduced in 1997, tubular discectomy involves a similar procedure to the one described above, with the exception that it is performed through a tubular device. This type of herniated disc surgery has been described as producing less tissue damage and resulting in a faster rate of recovery, the latter point serving as the basis of examination for the Sciatica Micro-Endoscopic Discectomy trial.

Performed by researchers in the Netherlands, this trial involved 328 patients (ages 18 to 70 years) who:

  • had persistent leg pain from lumbar herniated discs for more than 8 weeks
  • were hospitalized in 7 general hospitals in the Netherlands from January 2005 to October 2006
  • were randomized to either a tubular discectomy (approximately 167 patients) or conventional microdiscectomy (161 patients).

A blind follow up was conducted a year later, with functional ability, pain and a self-view of recovery assessed via a series of questionnaires and surveys.

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Findings on Microdiscectomy and Tubular Discectomy

According to the study, conventional microdiscectomy produced more favorable results than tubular discectomy after one year for:

  • functionality. The mean score on the Roland-Morris Disability Questionnaire (RDQ), which has a 0-23 score range with higher scores indicative of worse functional status, was 3.4 for conventional microdiscectomy and 4.7 for tubular discectomy.
  • leg pain. On the visual analog scale, the 1-year mean difference was in favor of conventional microdiscectomy (with scores of 4.2 mm for leg pain and 3.5 mm for back pain).
  • self-reports of recovery. 120 of 151 patients (79%) who had conventional microdiscectomy reported good recovery a year later while 107 of 156 of patients (69%) who had tubular discectomy reported good recovery a year after the minimally-invasive procedure.

It should be known that this randomized control trial by no means knocks the validity of tubular disectomy as a minimally-invasive procedure for herniated discs; rather, it challenges certain claims like it increasing the rates of recovery.

Source: JAMA

Article written by: Staff Writer