Surgical techniques for sciatica due to herniated disc, a systematic review

WCH Jacobs, MP Arts, MW van Tulder, SM Rubinstein, Marienke van Middelkoop, RW Ostelo, Arianne Verhagen, Bart Koes, WC Peul

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50 Citations (Scopus)

Abstract

Disc herniation with sciatica accounts for five percent of low-back disorders but is one of the most common reasons for spine surgery. The goal of this study was to update the Cochrane review on the effect of surgical techniques for sciatica due to disc herniation, which was last updated in 2007. In April 2011, we conducted a comprehensive search in CENTRAL, MEDLINE, EMBASE, CINAHL, PEDRO, ICL, and trial registries. We also checked the reference lists and citation tracking results of each retrieved article. Only randomized controlled trials (RCT) of the surgical management of sciatica due to disc herniation were included. Comparisons including chemonucleolysis and prevention of scar tissue or comparisons against conservative treatment were excluded. Two review authors independently selec Seven studies from the original Cochrane review were included and nine additional studies were found. In total, 16 studies were included, of which four had a low risk of bias. Studies showed that microscopic discectomy results in a significantly, but not clinically relevant longer operation time of 12 min (95 % CI 2-22) and shorter incision of 24 mm (95 % CI 7-40) compared with open discectomy, but did not find any clinically relevant superiority of either technique on clinical results. There we Due to the limited amount and quality of evidence, no firm conclusions on effectiveness of the current surgical techniques being open discectomy, microscopic discectomy, and tubular discectomy compared with each other can be drawn. Those differences in leg or back pain scores, operation time, and incision length that were found are clinically insignificant. Large, high-quality studies are needed, which examine not only effectiveness but cost-effectiveness as well.
Original languageUndefined/Unknown
Pages (from-to)2232-2251
Number of pages20
JournalEuropean Spine Journal
Volume21
Issue number11
DOIs
Publication statusPublished - 2012

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