TITLE

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

AUTHOR(S)
Peul, Wilco C.; van den Hout, Wilbert B.; Brand, Ronald; Thomeer, Ralph T.W.M.; Koes, Bart W.
PUB. DATE
June 2008
SOURCE
BMJ: British Medical Journal (International Edition);6/14/2008, Vol. 336 Issue 7657, p1355
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
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.
ACCESSION #
32746955

 

Related Articles

  • Tratamiento postquirúrgico de hernia discal lumbar en rehabilitación. Revisión sistemática. Santana-Ríos, J. S.; Chávez-Arias, D. D.; Coronado-Zarco, R.; Cruz-Medina, E.; Nava-Bringas, T. // Acta Ortopedica Mexicana;Mar/Apr2014, Vol. 28 Issue 2, p114 

    Various programs and interventions are available for the rehabilitation of patients who have undergone surgery for symptomatic lumbar disc herniation (LDH). Our aim is to determine the value of the different rehabilitation interventions included in the postoperative treatment of patients with...

  • Treatment by Tenderizer.  // Time;3/25/1974, Vol. 103 Issue 12, p86 

    The article offers information on the medical usage of papain, an enzyme derived from the papaya plant and sold in grocery stores as tenderizer. It mentions that the doctors in Boston, Massachusetts and Chicago, Illinois had been using the extract known medically as chymopapain to tenderize...

  • PERSPECTIVE. Hee Kit Wong // Orthopedics Today;Jul2011, Vol. 31 Issue 7, p26 

    The author comments on the study by Miyako Suzuki wherein Suzuki found that, in determining whether using local bone graft is as effective as iliac crest bone graft in case of L4 degenerative spondylolisthesis, there are fusion rates of 90% and 85%, respectively, in single-level instrumented cases.

  • Emergency Brake Response Time After First Metatarsal Osteotomy. Holt, G.; Kay, M.; McGrory, R.; Kumar, C. S. // Journal of Bone & Joint Surgery, American Volume;Aug2008, Vol. 90-A Issue 8, p1660 

    Background: There is sparse information upon which to recommend a return to activity after foot surgery. The purpose of this study was to determine whether six weeks is sufficient time for the emergency brake response time to return to preoperative levels after a first metatarsal osteotomy for...

  • Cementing Techniques for Hip Resurfacing Arthroplasty: Development of a Laboratory Model. Bitsch, Rudi G.; Loidolt, Travis; Heisel, Christian; Schmalzried, Thomas P. // Journal of Bone & Joint Surgery, American Volume;Aug2008 Supplement 3, Vol. 90-A, p102 

    Background: Hip resurfacing is extremely technique-sensitive, yet scientific investigations into cementing techniques are lacking. In this study, we tested open-cell, reticulated, carbon-foam materials in comparison with paired human femoral heads to validate a laboratory cementing model for...

  • Long-Term Independent Evaluation After Arthroscopic Extra-Articular Bankart Repair with Absorbable Tacks. Kartus, Catarina; Kartus, Jun; Matis, Nicholas; Forstner, Rosemarie; Resch, Herbert // Journal of Bone & Joint Surgery, American Volume;Oct2008 Supplement 2, Vol. 90-A, p262 

    BACKGROUND: Several arthroscopic methods have been developed to treat posttraumatic recurrent anterior shoulder instability in an attempt to match the results that can be achieved with open repair. The aim of this study was to perform an independent long-term clinical and radiographic evaluation...

  • High-Tension Double-Row Footprint Repair Compared with Reduced-Tension Single-Row Repair for Massive Rotator Cuff Tears. Domb, Benjamin G.; Glousman, Ronald E.; Brooks, Adam; Hansen, Matthew; Lee, Thay Q.; Neal S. ElAttrache // Journal of Bone & Joint Surgery, American Volume;Nov2008 Supplement 4, Vol. 90-A, p35 

    The article reports on the results of research which was conducted in an effort to compare the biomechanical behavior of high tension double row repair compared with reduced tension single row repair in the treatment of massive rotator cuff tears. A discussion of the challenges that a massive...

  • Hindfoot Endoscopy for Posterior Ankle Impingement. Scholten, P. E.; Sierevelt, I. N.; van Dijk, C. N. // Journal of Bone & Joint Surgery, American Volume;Dec2008, Vol. 90-A Issue 12, p2665 

    Background: The surgical treatment of posterior ankle impingement is associated with a high rate of complications and a substantial time to recover. An endoscopic approach to the posterior ankle (hindfoot endoscopy) may lack these disadvantages. We hypothesized that hindfoot endoscopy causes...

  • Distal Tibiofibular. Bone-Bridging in Transtibial Amputation. Pinzur, Michael S.; Beck, Jennifer; Himes, Ryan; Callaci, John // Journal of Bone & Joint Surgery, American Volume;Dec2008, Vol. 90-A Issue 12, p2682 

    Background: The creation of a bone bridge between the residual tibia and fibula is a controversial surgical technique used in the performance of transtibial amputation. Methods: Twenty consecutive patients who underwent a unilateral transtibial amputation, as a consequence of traumatic injury,...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics