Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study

Abstract

ObjectivesEvidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting.MethodsA prospective cohort study of a routine clinical practice registry consisting of 370 patients. Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life. Primary outcomes were back pain at 6 and 12 weeks. Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks. We filled in missing outcome variable values with multiple imputation, accounted for repeated measures within patients with mixed-effects models and adjusted baseline group differences in relevant prognostic indicators by inverse probability of treatment weighting.ResultsSurgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy (−0.97; 95% CI −1.89 to −0.09), were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks (48% vs 17%, risk difference: 0.34; 95% CI 0.16 to 0.47) and reported less physical function disability at 52 weeks (−3.7; 95% CI −7.4 to −0.1). The other assessments showed minimal between-group differences with CIs, including the null effect.ConclusionsCompared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up.

Lumbar Disc Herniation

“…Gugliotta et al recently demonstrated equivalent medium-and long-term outcomes for conservative and surgical treatment of LDH [47]. However, other studies have also demonstrated improved 1-and 2-year outcomes in the surgical treated group when compared to conservatively managed patients.…”

Markers of inflammation and fibrinolysis in relation to outcome after surgery for lumbar disc herniation. A prospective study on 177 patients

“…The so fare latest study came in autumn 2016, when Gugliotta et al presented a cohort study on 370 routinely treated patients, without randomization and with 20% non-surgically treated [62]. Even in this study surgery showed to be better up to three months, but not thereafter.…”

“…Lifetime incidence of having a symptomatic lumbar disc herniation, is a more uncertain calculation, but Frymoyer found between 13-40% 1992 [59] and Gugliotta et al 30%, in a recent paper [62].…”

Surgical tactics for multilevel displacements of lumbar intervertebral discs

“…1 , Шульга А.Н. 1 , Зорин Н.Н. 2 Цель: улучшить результаты хирургического лечения поясничных болевых синдромов и радикулопатии, вызванных многоуровневым смещением межпозвонковых дисков пояснично-крестцового отдела позвоночника.…”

“…Вступ У хворих із поперековим болем та радикулопатією одночасне зміщення двох і більше поперекових міжхребцевих дисків (ПМХД) явище не рідкісне [1]. За даними авторів, багаторівневе зміщення ПМХД трапляється в 38-56 % випадків [2,3].…”