Prolonged conservative care versus early surgery in patients with
sciatica caused by lumbar disc herniation: two year results of a randomised
controlled trial |
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Authors: | Wilco C Peul Wilbert B van den Hout Ronald Brand Ralph T W M Thomeer Bart W Koes |
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Institution: | 1.Department of Neurosurgery, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands;2.Department of Neurosurgery, Medical Centre Haaglanden, The Hague, Netherlands;3.Department of Medical Decision Making, Leiden University Medical Centre;4.Department of Medical Statistics, Leiden University Medical Centre;5.Research Department of General Practice, Erasmus Medical Centre, 3000 CA Rotterdam, the Netherlands |
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Abstract: | Objectives To evaluate the effects of early lumbar disc surgery
compared with prolonged conservative care for patients with sciatica over two
years of follow-up.Design Randomised controlled trial.Setting Nine Dutch hospitals.Participants 283 patients with 6-12 weeks of sciatica.Interventions Early surgery or an intended six months of continued
conservative treatment, with delayed surgery if needed.Main outcome measures Scores from Roland disability questionnaire
for sciatica, visual analogue scale for leg pain, and Likert self rating scale
of global perceived recovery.Results Of the 141 patients assigned to undergo early surgery, 125
(89%) underwent microdiscectomy. Of the 142 patients assigned to conservative
treatment, 62 (44%) eventually required surgery, seven doing so in the second
year of follow-up. There was no significant overall difference between treatment
arms in disability scores during the first two years (P=0.25). Improvement in
leg pain was faster for patients randomised to early surgery, with a significant
difference between “areas under the curves” over two years (P=0.05). This short
term benefit of early surgery was no longer significant by six months and
continued to narrow between six months and 24 months. Patient satisfaction
decreased slightly between one and two years for both groups. At two years 20%
of all patients reported an unsatisfactory outcome.Conclusions Early surgery achieved more rapid relief of sciatica
than conservative care, but outcomes were similar by one year and these did not
change during the second year.Trial Registry ISRCT No 26872154. |
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