Early Versus Delayed Microdiscectomy for Chronic Sciatica Lasting 4–12 Months Secondary to Lumbar Disc Herniation: A Secondary Analysis of a Randomized Controlled Trial

Global Spine Journal, 2023 · DOI: 10.1177/21925682211054040 · Published: July 1, 2023

Simple Explanation

This study investigates whether delaying surgery for chronic sciatica (leg pain caused by a herniated disc in the lower back) affects patient outcomes compared to having surgery sooner. Patients were divided into two groups: one received early surgery, and the other initially received non-surgical treatment, with surgery if needed later. The study found that patients who had delayed surgery experienced less improvement in leg pain, back pain, and overall physical function compared to those who had early surgery. This suggests that waiting to have surgery for chronic sciatica may lead to worse outcomes. These findings suggest that early surgical intervention might be more beneficial for individuals suffering from chronic sciatica due to lumbar disc herniation, rather than prolonged non-operative care followed by delayed surgery.

Study Duration

6 years (screening period from February 2010 through August 2016)

Participants

128 patients with sciatica lasting 4–12 months and lumbar disc herniation

Evidence Level

Level I, Secondary Analysis of Randomized Controlled Trial

Key Findings

1
The early surgery group experienced less leg pain than the delayed surgery group at 6 months after surgery.
2
The overall estimated mean difference between groups significantly favored early surgery for leg pain, ODI, SF36-PCS, and back pain.
3
Patients undergoing delayed surgery had worse outcomes compared to those undergoing early surgery.

Research Summary

This study compares early microdiscectomy versus delayed surgery following non-operative care for chronic sciatica secondary to lumbar disc herniation, finding that early surgery leads to superior outcomes in terms of leg pain, disability, and physical function. Patients who underwent delayed surgery after failing 6 months of non-operative care had poorer patient-rated outcome measures than those who received early surgery, highlighting the potential negative consequences of prolonged non-operative treatment. The findings suggest that a system-imposed wait for surgery, common in publicly funded healthcare systems, could negatively impact outcomes following lumbar discectomy, emphasizing the need to carefully consider the timing of surgical intervention.

Practical Implications

Informed Decision-Making

Patients with chronic sciatica should be informed about the potential benefits of early surgery compared to delayed surgery after non-operative care.

Healthcare System Optimization

Healthcare systems should consider enhanced access to microdiscectomy to avoid potentially deleterious effects of delayed treatment on patient outcomes.

Treatment Timing

Surgeons and patients should carefully weigh the decision to pursue non-operative care with the understanding that delaying surgery may lead to inferior results.

Study Limitations

1
Secondary analysis of a randomized controlled study
2
Accessors were blinded, but surgeons, physicians, therapists, or patients were not blinded to the treatment.
3
Lost to follow-up rate declined to 73% by the 1-year time point.

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