Effectiveness of Microdiscectomy for Lumbar Disc Herniation: A Randomized Controlled Trial With 2 Years of Follow-up

Heikki Österman, MD; Seppo Seitsalo, MD, PhD; Jaro Karppinen, MD, PhD; Antti Malmivaara, MD, PhD

Disclosures

Spine. 2006;31(21):2409-2414. 

In This Article

Abstract and Introduction

Abstract

Study Design: Prospective randomized controlled trial.
Objective: To assess effectiveness of microdiscectomy in lumbar disc herniation patients with 6 to 12 weeks of symptoms but no absolute indication for surgery.
Summary of Background Data: There is limited evidence in favor of discectomy for prolonged symptoms of lumbar disc herniation. However, only one randomized trial has directly compared discectomy with conservative treatment.
Methods: Fifty-six patients (age range, 20-50 years) with a lumbar disc herniation, clinical findings of nerve root compression, and radicular pain lasting 6 to 12 weeks were randomized to microdiscectomy or conservative management. Fifty patients (89%) were available at the 2-year follow-up. Leg pain intensity was the primary outcome measure.
Results: There were no clinically significant differences between the groups in leg or back pain intensity, subjective disability, or health-related quality of life over the 2-year follow-up, although discectomy seemed to be associated with a more rapid initial recovery. In a subgroup analysis, discectomy was superior to conservative treatment when the herniation was at L4-L5.
Conclusions: Lumbar microdiscectomy offered only modest short-term benefits in patients with sciatica due to disc extrusion or sequester. Spinal level of the herniation may be an important factor modifying effectiveness of surgery, but this hypothesis needs verification.

Introduction

Elective discectomy is regarded as a good treatment option for lumbar disc herniation if severe pain or neurologic deficit persist after 4 to 6 weeks of conservative therapy.[1] Standard open discectomy and microdiscectomy seem to be equally effective.[2]

Wide regional variations in lumbar discectomy rates reflect insufficient knowledge of effectiveness of discectomy.[3,4,5] Since 1934, when Mixter and Barr reported on the first series of operated patients, only one randomized trial has compared discectomy with conservative treatment.[6,7] The clinical outcome in surgical patients was superior at 1 year, but after 4 years there were no significant differences between the treatment groups. The Weber study remains a classic despite methodologic critique presented, but it has become outdated.[8] In a prospective cohort study, surgical treatment was associated with greater improvement than nonsurgical treatment, although relative benefit of surgery decreased over time.[9,10]

We aimed to assess effectiveness of modern microdiscectomy in patients with lumbar disc herniation and symptoms prolonged enough to merit elective operation by current clinical treatment guidelines.

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