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Previous Volume 356:2245-2256 May 31, 2007 Number 22 Next

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ABSTRACT

Background Lumbar-disk surgery often is performed in patients who have sciatica that does not resolve within 6 weeks, but the optimal timing of surgery is not known.

Methods We randomly assigned 283 patients who had had severe sciatica for 6 to 12 weeks to early surgery or to prolonged conservative treatment with surgery if needed. The primary outcomes were the score on the Roland Disability Questionnaire, the score on the visual-analogue scale for leg pain, and the patient's report of perceived recovery during the first year after randomization. Repeated-measures analysis according to the intention-to-treat principle was used to estimate the outcome curves for both groups.

Results Of 141 patients assigned to undergo early surgery, 125 (89%) underwent microdiskectomy after a mean of 2.2 weeks. Of 142 patients designated for conservative treatment, 55 (39%) were treated surgically after a mean of 18.7 weeks. There was no significant overall difference in disability scores during the first year (P=0.13). Relief of leg pain was faster for patients assigned to early surgery (P<0.001). Patients assigned to early surgery also reported a faster rate of perceived recovery (hazard ratio, 1.97; 95% confidence interval, 1.72 to 2.22; P<0.001). In both groups, however, the probability of perceived recovery after 1 year of follow-up was 95%.

Conclusions The 1-year outcomes were similar for patients assigned to early surgery and those assigned to conservative treatment with eventual surgery if needed, but the rates of pain relief and of perceived recovery were faster for those assigned to early surgery. (Current Controlled Trials number, ISRCTN26872154 [controlled-trials.com] .)

Source Information

From the Departments of Neurosurgery (W.C.P., R.T.W.M.T.), Medical Statistics (H.C.H., R.B.), Medical Decision Making (W.B.H.), and Public Health and Primary Care (J.A.H.E.), Leiden University Medical Center, Leiden; the Department of Neurology and Neurosurgery, Medical Center Haaglanden, The Hague (W.C.P., J.T.J.T.); and the Department of General Practice, Erasmus University Medical Center, Rotterdam (B.W.K.) — all in the Netherlands.

Address reprint requests to Dr. Peul at the Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands, or at w.c.peul{at}lumc.nl.

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