Clin Orthop Relat Res, 2022 · DOI: 10.1097/CORR.0000000000002001 · Published: October 1, 2021
This study looked at whether surgery (microdiscectomy) is a better value than 6 months of non-surgical treatment for people with long-lasting sciatica (leg pain) caused by a herniated disc in the lower back. The analysis considered both the costs and the health benefits of each treatment. The researchers used a model to compare the costs and quality of life improvements (QALYs) for patients who had surgery versus those who tried non-surgical treatments first. The model used data from a previous study and cost information from Ontario, Canada. The study found that surgery was more cost-effective than non-surgical treatment for chronic sciatica. Although surgery cost more initially, it resulted in greater improvements in patients' quality of life, making it a worthwhile investment.
Decision-makers should ensure adequate funding to allow timely access to surgical care for patients with chronic sciatica, as early surgical intervention is potentially cost-effective.
Persisting with nonsurgical care that is costly and less effective should be questioned by payers, and resources potentially allocated to ensure faster access to surgical management for patients with chronic radiculopathy.
Future studies should incorporate societal impacts of care, such as lost productivity, to generate stronger justification for early surgery in patients with prolonged discogenic radiating leg pain.