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. 2012 Nov;21(11):2232-51.
doi: 10.1007/s00586-012-2422-9. Epub 2012 Jul 20.

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

Wilco C H Jacobs  1 , Mark P Arts, Maurits W van Tulder, Sidney M Rubinstein, Marienke van Middelkoop, Raymond W Ostelo, Arianne P Verhagen, Bart W Koes, Wilco C Peul
Affiliations

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

Wilco C H Jacobs et al. Eur Spine J. 2012 Nov.

Abstract

Introduction: 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.

Materials and methods: 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 selected studies, assessed risk of bias of the studies and extracted data. Quality of evidence was graded according to the GRADE approach.

Results: 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 were conflicting results regarding the comparison of tubular discectomy versus microscopic discectomy for back pain and surgical duration.

Conclusions: 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.

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Figures

Fig. 1
Fig. 1
Flow chart for inclusion of studies
Fig. 2
Fig. 2
Forest plot for VAS leg pain between microscopic discectomy and open discectomy
Fig. 3
Fig. 3
Forest plot for operating time between microscopic discectomy and open discectomy
Fig. 4
Fig. 4
Forest plot for length of stay between microscopic discectomy and open discectomy
See this image and copyright information in PMC

References

    1. NIH Clinical Trials database (2011) http://clinicaltrials.gov/. Accessed 1 Jun 2011
    1. The International Standard Randomized Controlled Trial Number Register (ISRCTN) (2011) http://www.controlled-trials.com/. Accessed 1 Jun 2011
    1. USFDA trial register, post approval studies (2011) http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMA/pma_pas.cfm. Accessed 1 Jun 2011
    1. Arts M, Brand R, van der Kallen B, Nijeholt G, Peul W. Does minimally invasive lumbar disc surgery result in less muscle injury than conventional surgery? A randomized controlled trial. Eur Spine J. 2011;20(1):51–57. doi: 10.1007/s00586-010-1482-y. - DOI - PMC - PubMed
    1. Arts MP, Brand R, Koes BW, Peul WC. Effect modifiers of outcome of surgery in patients with herniated disc related sciatica? A subgroup analysis of a randomised clinical trial. J Neurol Neurosurg Psychiatry. 2010;81(11):1265–1274. doi: 10.1136/jnnp.2009.192906. - DOI - PubMed

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