Treatment of the Isolated Lumbar Intervertebral Disc Herniation: Microdiscectomy Versus Chemonucleolysis

Watters, William C.; Mirkovic, Srdjan; Boss, James

doi:10.1097/00007632-198803000-00025

Cited by 18 publications

(6 citation statements)

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“…Eight studies 48,49,54,76,88,92,104,105 compared disc surgery with chemonucleolysis, for which there was no overall difference between the groups. Only one of these studies was an RCT, 88 of moderate quality, which found chemonucleolysis more effective than disc surgery.…”

Section: Tablementioning

confidence: 99%

“…The diagnosis of sciatica, or the presence of herniated disc, was confirmed by imaging in 31 (84%) studies. Two studies 49,105 compared the use of chemonucleolysis with disc surgery in only patients who had sciatica for the first time, and one study 50 compared the same intervention in patients who had recurrent sciatica. The remaining studies included a mixture of patients with either first episode or recurrent sciatica or, more usually, did not report this information.…”

Section: Summary Of Study Participants For Chemonucleolysismentioning

confidence: 99%

“…Eight studies 48,54,76,92,160,168,205,210 only included patients with chronic symptoms. The remaining studies included patients with either acute or chronic sciatica 49,105,170,206,207 or did not state the duration of symptoms. 88,104,209 The duration of follow-up ranged from 2 to 6 months, or mean 13 105 to 23 weeks.…”

Section: Condition-specific Outcome Measures At Short-term Follow-upmentioning

confidence: 99%

“…The remaining studies included patients with either acute or chronic sciatica 49,105,170,206,207 or did not state the duration of symptoms. 88,104,209 The duration of follow-up ranged from 2 to 6 months, or mean 13 105 to 23 weeks. 206 Pooled analysis of five RCTs [205][206][207][208][209][210] showed chemonucleolysis to be significantly better than inactive control for overall recovery at 3-6 months 205,207,209,210 or mean 23 weeks.…”

Section: Condition-specific Outcome Measures At Short-term Follow-upmentioning

confidence: 99%

“…206 Pooled analysis of five RCTs [205][206][207][208][209][210] showed chemonucleolysis to be significantly better than inactive control for overall recovery at 3-6 months 205,207,209,210 or mean 23 weeks. 206 Eight studies 48,49,54,76,88,92,104,105 compared chemonucleolysis and disc surgery, for which there was no overall difference between the groups. One moderate-quality RCT 88 found chemonucleolysis to be more effective than disc surgery.…”

Section: Condition-specific Outcome Measures At Short-term Follow-upmentioning

confidence: 99%

See 4 more Smart Citations

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

Lewis

Williams²,

Matar³

et al. 2011

Health Technol Assess

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTAThe clinical effectiveness and costeffectiveness of management strategies for sciatica: systematic review and economic model NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA pro...

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Section: Tablementioning

confidence: 99%

Section: Summary Of Study Participants For Chemonucleolysismentioning

confidence: 99%

Section: Condition-specific Outcome Measures At Short-term Follow-upmentioning

confidence: 99%

Section: Condition-specific Outcome Measures At Short-term Follow-upmentioning

confidence: 99%

Section: Condition-specific Outcome Measures At Short-term Follow-upmentioning

confidence: 99%

See 3 more Smart Citations

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

Lewis

Williams²,

Matar³

et al. 2011

Health Technol Assess

View full text Add to dashboard Cite

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Percutaneous Treatments

Postacchini¹,

Mayer²

1999

Lumbar Disc Herniation

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Management of the herniated lumbar disc: the outcome after chemonucleolysis, surgical disc excision and conservative treatments

1992

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In the 11-year period from 1978 and 1988, myelography was performed on 624 patients with suspected herniated lumbar discs. Positive findings, defined as an indentation of the contrast-filled dural sac and/or lack of contrast filling of the nerve roots, were found in 508 (81.4%) patients. Patients with suspected spinal stenosis were excluded from the study. The choice of treatment was determined by the preference of the consultant in charge. In all, 146 patients were treated by chemonucleolysis, 152 patients underwent surgical excision of the disc via laminectomy/fenestration, while 210 patients were listed for further treatment (albeit chemonucleolysis or laminectomy) but sustained relief of symptoms whilst waiting for admission or refused further intervention and consequently continued conservative treatments (such as physiotherapy, manipulations under anaesthetic, epidural or local injections). Following a repetitive questionnaire and clinical review, 78% of those patients that had undergone chemonucleolysis were satisfied with their treatment (i.e. symptoms were either 'gone', 'much better' or 'better'). Significantly fewer patients were satisfied after surgical disc excision or conservative treatments (71% and 61%, respectively; P <0.001). Whereas patients with a short duration of symptoms (less than 1 year) achieved the best outcome after chemonucleolysis and laminectomy, patients with a prolonged history (greater than 2 years) benefitted most from conservative methods. Of those patients in whom symptoms were considered to be worse or the same following treatment, 46%, 51% and 42% were still working following chemonucleolysis, surgery and conservative treatment, respectively. The outcome did not depend upon the size of the disc involved. Although this is a retrospective study, it is the first report to compare the outcome following chemonucleolysis, surgery and conservative methods in patients with disc prolapse confirmed by myelography.

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Treatment of the Isolated Lumbar Intervertebral Disc Herniation: Microdiscectomy Versus Chemonucleolysis

Cited by 18 publications

References 0 publications

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

Percutaneous Treatments

Management of the herniated lumbar disc: the outcome after chemonucleolysis, surgical disc excision and conservative treatments

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