The type of treatment for chronic radiculopathy (sciatica) caused by a herniated disc can be a complicated task. The main question is when we offer the patient surgery and when we treat with painkillers and physiotherapy.
In a very important article in the New England Journal of Medicine 32187469
, colleagues from Western University, Ontario, Canada, give a clear answer.
In a single-center randomized study of patients with sciatica, up to 4 to 12 months, and lumbar disc herniation at the level of L4 - L5 or L5 - S1 in a ratio of 1: 1, a) surgery - microdiscectomy or b) 6 months of standardized non-surgical care. Surgery is performed by spinal surgeons who use conventional microdiscectomy techniques. There were 64 in each group. Before treatment, the mean VAS pain intensity measured in the leg was 7.7 in the operated patients and 8.0 in the non-operated patients. The intensity of leg pain six months after treatment was 2.8 in the operated group and 5.2 in the non-operated. The secondary results were also in the same direction as the main result.
This study demonstrates that in a patient who suffers from sciatica caused by a lumbar disc herniation for more than four months, surgical treatment is more successful than conservative treatment.
The original article:
Surgery Versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months Chris S Bailey 1, Parham Rasoulinejad 1, David Taylor 1, Keith Sequeira 1, Thomas Miller 1, Jim Watson 1, Richard Rosedale 1, Stewart I Bailey 1, Kevin R Gurr 1 , Fawaz Siddiqi 1, Andrew Glennie 1, Jennifer C Urquhart 1 N Engl J Med. 2020 Mar 19; 382 (12): 1093-1102. doi: 10.1056 / NEJMoa1912658.