Wednesday, October 30, 2001 7:40–8:23 am General Session 1: Surgery Outcomes: 7:40 Microdiscectomy versus conservative treatment for lumbar disc herniation: a randomized clinical trial

Abstract

Purpose of study: To compare clinical outcomes of lumbar microdiscectomy (MD) and conservative care (CC) in patients with lumbar disc herniation (LDH).Methods used: Eighty-eight patients with low back pain (LBP) and sciatica, plus magnetic resonance imaging evidence of a small/moderate LDH were allocated to MD or to CC with proactive exercise and education. Patients with compelling indication for surgery (major neurological symptoms or severe sciatica), spinal stenosis, major pathology or previous spinal surgery were excluded. Primary outcomes were pain (visual analogue scales [VAS]) and disability (Oswestry Disability Index [ODI]). Other measures included the short form (SF)-36 and shuttle walk test. Eighty subjects remained in the study at 12 months.of findings: Mean age was 39.8 years. Mean ratio of back/leg pain was 45/ 55. Baseline group characteristics were well balanced. Outcome data were analyzed using regression of treatment group on each measure adjusting for baseline values. MD patients had greater reduction in pain and ODI scores, with significant differences at each time point (Table 1)Table 1Disability and painTime (months)Surgery (mean)Conservative care (mean)Difference (adjusted for baseline values)p ValueDisability (ODI)041.141.2325.237.411.7.001620.433.813.3.0001217.928.511.1.003LBP (VAS)05.45.433.15.01.9.00062.74.51.9.000122.44.21.8.002Sciatica (VAS)06.36.232.65.22.5.00062.54.82.3.000122.33.91.7.007, and improvement with time was observed in both groups.Relationship between findings and existing knowledge: Nonrandomized studies in LDH have reported superior outcome with surgery, with differences decreasing over time. One RCT with 10-year follow-up in 1983 showed superior outcome with surgery only at 1 year. Our results support these findings at the 1-year stage and suggest that back pain as well as nerve root pain is reduced.Overall significance of findings: The threshold for surgical intervention in this patient group, with moderate disability related to both back and leg pain, remains uncertain, reflected in wide variations of rates for surgery. This study reports significant benefits in the first 12 months with MD, and the magnitude of differences between groups suggests that MD may be worthwhile even if this gap closes at a later stage. It is noteworthy, however, that in both groups there are those who do well and those who do not. Longer-term follow-up and study of the influence of predictive factors in this patient group is recommended.Disclosures: No disclosures.Conflict of interest: No conflicts.