Understanding how the research question impacts trial design: Examples from discectomy trials

Raymond, Jean; Chan, Vivien K.Y.; Darsaut, T.E.

doi:10.1016/j.neuchi.2023.101460

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…However, some patients may prefer conservative over surgical treatment, especially if they think that conservative would be beneficial or if they have any concerns about the risk of surgery. For instance, although 40% of patients referred to spinal manipulative therapy for LDH-induced sciatica may fail to achieve satisfactory relief, the evident risk and cost profile associated with operative care argue for careful consideration by physicians and patients of spinal manipulative therapy before opting for surgical intervention [ 30 ].…”

Section: Reviewmentioning

confidence: 99%

Surgical vs. Conservative Management of Chronic Sciatica (>3 Months) Due to Lumbar Disc Herniation: Systematic Review and Meta-Analysis

Hammed,

Al-Qiami,

Alsalhi

et al. 2024

Cureus

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Sciatica, characterized by leg or back symptoms along the sciatic nerve pathway, often manifests as a chronic condition lasting over 12 weeks. Decision-making between nonoperative treatment and immediate microdiscectomy for chronic sciatica remains challenging, due to the complex relationship between symptom duration, severity, and lumbar discectomy outcomes. In this systematic review, we conducted a comprehensive search across Scopus, PubMed, Web of Science, and the Cochrane Library, identifying relevant two-arm clinical trials up to September 2023. Rigorous screening and data extraction were performed by two independent reviewers, with study quality evaluated using the risk of bias 2 (RoB) tool. This meta-analysis incorporated four studies comprising 352 participants. Our analysis revealed that conservative treatment was associated with a significant reduction in leg pain and improvement in, SF mental, and physical scores compared to surgical intervention. However surgical treatment demonstrated significant improvement in back pain. In conclusion, our findings suggest that surgical intervention may be more effective than non-surgical treatment for chronic sciatica-related back pain. Conservative treatment significantly reduces leg pain while improving mental and physical health outcomes. Ultimately, our findings support conservative as the initial approach unless surgery is warranted, particularly in cases with neurological deficits or cauda equina syndrome.

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Section: Reviewmentioning

confidence: 99%