Patients with chronic sciatica secondary to lumbar disc herniation who receive delayed surgery following prolonged, standardised non-operative care have inferior outcomes to those who undergo expedited surgery, new research has indicated.
The results from a secondary analysis of a previously conducted randomised controlled trial—which sought to determine if surgery is superior to non-operative care for sciatica caused by a lumbar disc herniation—were published recently by Christopher Bailey (London Health Science Centre, Ontario, Canada) et al in the Global Spine Journal.
“For patient and surgeon preference, this has important implications in the decision to pursue non-operative versus operative care. Furthermore, it demonstrates the potentially deleterious effect a system-imposed wait, such as that experienced in publicly funded health care system, could have in outcome following lumbar discectomy,” note the researchers.
A total of 128 patients with sciatica lasting between four and 12 months and lumbar disc herniation at the L4–L5 or L5–S1 level were randomised to undergo microdiscectomy (early surgery) or to receive six months of nonoperative treatment followed by surgery if needed (delayed surgery).
Outcomes were assessed preoperatively and at six weeks, three months, six months, and one year after surgery. The primary outcome was the Visual Analogue Scale (VAS) for intensity of leg pain measured at six months following surgery.
Secondary outcomes which were measured at three months, six months, and one year were the VAS intensity for leg pain, VAS for intensity of low back pain, the Oswestry Disability Index (ODI), Medical Outcomes Study 36-item Short-Form General Health Survey (SF36) physical component summary (PCS) score and mental component summary score, employment status, and satisfaction with treatment. Adverse events related to surgical treatment were documented for up to one year after surgery.
Of the 64 patients in the early surgery group, a total of 56 underwent microdiscectomy an average of 3 ± 2 weeks after enrolment. Of the 64 patients randomised to nonoperative care, 22 patients underwent delayed surgery an average of 53 ± 24 weeks after enrolment.
The analysis found that those in the early surgery group experienced less leg pain than the delayed surgery group at six months after surgery (2.8 ± 0.4 vs. 4.8 ± 0.7; difference, 2; 95% confidence interval (CI), 0.5–3.5). In addition, the overall estimated mean difference between groups significantly favoured early surgery for leg pain, ODI, SF36-PCS, and back pain. The adverse event rate was similar between the early surgery group (n=4) and the delayed surgery group (n=5).