Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review

被引:260
作者
Jacobs, Wilco C. H. [1 ]
van Tulder, Maurits [2 ,3 ]
Arts, Mark [4 ]
Rubinstein, Sidney M. [3 ]
van Middelkoop, Marienke [5 ]
Ostelo, Raymond [2 ,3 ]
Verhagen, Arianne [5 ]
Koes, Bart [5 ]
Peul, Wilco C. [1 ]
机构
[1] Leiden Univ, Med Ctr, Dept Neurosurg, NL-2300 RC Leiden, Netherlands
[2] Vrije Univ Amsterdam, EMGO Inst Hlth & Care Res, Fac Earth & Life Sci, Dept Hlth Sci, NL-1081 HV Amsterdam, Netherlands
[3] Vrije Univ Amsterdam, Med Ctr, EMGO Inst Hlth & Care Res, Dept Epidemiol & Biostat, NL-1081 HV Amsterdam, Netherlands
[4] Med Ctr Haaglanden, Dept Neurosurg, NL-2512 VA The Hague, Netherlands
[5] Univ Med Ctr Rotterdam, Erasmus MC, Dept Gen Practice, NL-3000 CA Rotterdam, Netherlands
关键词
Sciatica; Conservative treatment; Surgery; Discectomy; Systematic review; RANDOMIZED CONTROLLED-TRIAL; NONOPERATIVE TREATMENT; FOLLOW-UP; SPORT; CARE; PAIN;
D O I
10.1007/s00586-010-1603-7
中图分类号
R74 [神经病学与精神病学];
学科分类号
100204 [神经病学];
摘要
The effectiveness of surgery in patients with sciatica due to lumbar disc herniations is not without dispute. The goal of this study was to assess the effects of surgery versus conservative therapy (including epidural injections) for patients with sciatica due to lumbar disc herniation. A comprehensive search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to October 2009. Randomised controlled trials of adults with lumbar radicular pain, which evaluated at least one clinically relevant outcome measure (pain, functional status, perceived recovery, lost days of work) were included. Two authors assessed risk of bias according to Cochrane criteria and extracted the data. In total, five studies were identified, two of which with a low risk of bias. One study compared early surgery with prolonged conservative care followed by surgery if needed; three studies compared surgery with usual conservative care, and one study compared surgery with epidural injections. Data were not pooled because of clinical heterogeneity and poor reporting of data. One large low-risk-of-bias trial demonstrated that early surgery in patients with 6-12 weeks of radicular pain leads to faster pain relief when compared with prolonged conservative treatment, but there were no differences after 1 and 2 years. Another large low-risk-of-bias trial between surgery and usual conservative care found no statistically significant differences on any of the primary outcome measures after 1 and 2 years. Future studies should evaluate who benefits more from surgery and who from conservative care.
引用
收藏
页码:513 / 522
页数:10
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