Surgery versus prolonged conservative treatment for sciatica associated with lumbar disc herniation
Keywords:Herniated lumbar disc, Sciatica; Outcome research, Lumbar discectomy, Conservative management
Background and objective: There is little information available on comparing conservative versus immediate surgery results in the long run for patients with lumbar disc herniation in the modern clinical practice. The aim of this study was to assess one-year outcomes of patients with sciatica resulting from a lumbar disc herniation treated surgically versus non-surgically in two hospitals in Erbil
Methods: A prospective comparative cohort study was conducted over two years (January 2010 to February 2012). A sample 100 patients, 50 treated surgically and 50 conservatively, were followed up for one year. All participants had baseline interviews with follow-up questionnaires filled in the next specially designed follow up visits along the study time at regular intervals of 2, 8, 28 and 52 weeks. The outcome included patient-reported symptoms of leg and back pain, functional status, satisfaction versus expectation and working capacity after treatment or overall disability degree.
Results: Change in the modified Roland back-specific functional status scale favored surgical treatment initially, and the relative benefit decreased but persisted over the follow-up period. Despite these differences, work and disability status at one year were comparable among those treated surgically or non-surgically.
Conclusion: Surgically treated patients with a herniated lumbar disc had more complete relief of leg pain and improved function and satisfaction compared with non-surgically treated patients over one year. Nevertheless, improvement in the patient's predominant symptom and work and disability outcomes were closely similar regardless of treatment received
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