Surgical interventions for lumbar disc prolapse

Abstract

Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. Microdiscectomy gives broadly comparable results to open discectomy. The evidence on other minimally invasive techniques remains unclear (with the exception of chemonucleolysis using chymopapain, which is no longer widely available).

Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis

“…In the context of previous related systematic reviews, our findings are in general agreement that surgery for disc herniation provides faster short-term relief over non-surgical management for sciatica throughout the first 3 months, [14,45,46] 6 months [47] and 1-year follow-up [10], although no differences were found after 1 and 2 years in one review [14]. Regarding spinal stenosis, our results are also in general agreement with several reviews, that surgery is superior to non-surgical therapy through 1 to 2 years [45].…”

Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis

“…In the context of previous related systematic reviews, our findings are in general agreement that surgery for disc herniation provides faster short-term relief over non-surgical management for sciatica throughout the first 3 months, [14,45,46] 6 months [47] and 1-year follow-up [10], although no differences were found after 1 and 2 years in one review [14]. Regarding spinal stenosis, our results are also in general agreement with several reviews, that surgery is superior to non-surgical therapy through 1 to 2 years [45].…”

The McKenzie Method versus guideline-based advice in the treatment of sciatica: 24-month outcomes of a randomised clinical trial

“…Altogether, 19 sciatica patients had surgery due to lumbar disc herniation during the 24-month follow-up, and the surgery rates did not differ between groups. The prevalence rates of herniated disc surgeries may vary markedly between different countries and between different healthcare districts in the same country 5,9,27 The total surgery rate of 29% in the present study is in the range from 5% to 54% of previous studies. 5,28 The reason for the apparently high surgery rate in the present study may be that the study population comprised patients commonly treated conservatively in primary healthcare for up to 6 weeks according to guidelines before referral to specialist healthcare, or even longer depending on the severity of symptoms and the patient's preference for conservative treatment.…”

Magnifying Loupes Versus Microscope for Microdiscectomy and Microdecompression

“…11 Our VAS improvement after surgery is better for leg and back pain as shown in Figures. 2 In our study group, there appears to be a significant difference in the outcome between the loupes and the microscope groups. The VAS improvement for leg pain is slightly better in the microscope group than in the loupes group, but it was not statistically significant at P < 0.05.…”

Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis

“…In the context of previous related systematic reviews, our findings are in general agreement that surgery for disc herniation provides faster short-term relief over non-surgical management for sciatica throughout the first 3 months, [14,45,46] 6 months [47] and 1-year follow-up [10], although no differences were found after 1 and 2 years in one review [14]. Regarding spinal stenosis, our results are also in general agreement with several reviews, that surgery is superior to non-surgical therapy through 1 to 2 years [45].…”

The McKenzie Method versus guideline-based advice in the treatment of sciatica: 24-month outcomes of a randomised clinical trial

“…Altogether, 19 sciatica patients had surgery due to lumbar disc herniation during the 24-month follow-up, and the surgery rates did not differ between groups. The prevalence rates of herniated disc surgeries may vary markedly between different countries and between different healthcare districts in the same country 5,9,27 The total surgery rate of 29% in the present study is in the range from 5% to 54% of previous studies. 5,28 The reason for the apparently high surgery rate in the present study may be that the study population comprised patients commonly treated conservatively in primary healthcare for up to 6 weeks according to guidelines before referral to specialist healthcare, or even longer depending on the severity of symptoms and the patient's preference for conservative treatment.…”

Magnifying Loupes Versus Microscope for Microdiscectomy and Microdecompression

“…11 Our VAS improvement after surgery is better for leg and back pain as shown in Figures. 2 In our study group, there appears to be a significant difference in the outcome between the loupes and the microscope groups. The VAS improvement for leg pain is slightly better in the microscope group than in the loupes group, but it was not statistically significant at P < 0.05.…”

Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis

“…In the context of previous related systematic reviews, our findings are in general agreement that surgery for disc herniation provides faster short-term relief over non-surgical management for sciatica throughout the first 3 months, [14,45,46] 6 months [47] and 1-year follow-up [10], although no differences were found after 1 and 2 years in one review [14]. Regarding spinal stenosis, our results are also in general agreement with several reviews, that surgery is superior to non-surgical therapy through 1 to 2 years [45].…”

The McKenzie Method versus guideline-based advice in the treatment of sciatica: 24-month outcomes of a randomised clinical trial

“…Altogether, 19 sciatica patients had surgery due to lumbar disc herniation during the 24-month follow-up, and the surgery rates did not differ between groups. The prevalence rates of herniated disc surgeries may vary markedly between different countries and between different healthcare districts in the same country 5,9,27 The total surgery rate of 29% in the present study is in the range from 5% to 54% of previous studies. 5,28 The reason for the apparently high surgery rate in the present study may be that the study population comprised patients commonly treated conservatively in primary healthcare for up to 6 weeks according to guidelines before referral to specialist healthcare, or even longer depending on the severity of symptoms and the patient's preference for conservative treatment.…”

Magnifying Loupes Versus Microscope for Microdiscectomy and Microdecompression

“…11 Our VAS improvement after surgery is better for leg and back pain as shown in Figures. 2 In our study group, there appears to be a significant difference in the outcome between the loupes and the microscope groups. The VAS improvement for leg pain is slightly better in the microscope group than in the loupes group, but it was not statistically significant at P < 0.05.…”