Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial.

Wilco C Peul, Wilbert B van den Hout,   Ronald Brand,  , Ralph T W M ThomeerBart W Koes,  for the Leiden-The Hague Spine Intervention Prognostic Study Group

This is the 2 year follow up study from a trial that reported 1 year outcomes comparing surgery to conservative treatment for patients with sciatica.

283 patients with 6-12 weeks of sciatica were randomised into two groups for early surgery or an intended six months of continued conservative treatment, with delayed surgery if needed.

Outcome measures used were  Roland disability questionnaire for sciatica, visual analogue scale for leg pain, and Likert self rating scale of global perceived recovery.

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 groups during the first two years (P=0.25) although. Improvement in leg pain was faster for patients randomised to early surgery. 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.

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.

BMJ, doi:10.1136/bmj.a143 (published 23 May 2008)

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