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Open Access 01-11-2012 | Review Article

Surgical techniques for sciatica due to herniated disc, a systematic review

Authors: Wilco C. H. Jacobs, Mark P. Arts, Maurits W. van Tulder, Sidney M. Rubinstein, Marienke van Middelkoop, Raymond W. Ostelo, Arianne P. Verhagen, Bart W. Koes, Wilco C. Peul

Published in: European Spine Journal | Issue 11/2012

Abstract

Introduction

Disc herniation with sciatica accounts for five percent of low-back disorders but is one of the most common reasons for spine surgery. The goal of this study was to update the Cochrane review on the effect of surgical techniques for sciatica due to disc herniation, which was last updated in 2007.

Materials and methods

In April 2011, we conducted a comprehensive search in CENTRAL, MEDLINE, EMBASE, CINAHL, PEDRO, ICL, and trial registries. We also checked the reference lists and citation tracking results of each retrieved article. Only randomized controlled trials (RCT) of the surgical management of sciatica due to disc herniation were included. Comparisons including chemonucleolysis and prevention of scar tissue or comparisons against conservative treatment were excluded. Two review authors independently selected studies, assessed risk of bias of the studies and extracted data. Quality of evidence was graded according to the GRADE approach.

Results

Seven studies from the original Cochrane review were included and nine additional studies were found. In total, 16 studies were included, of which four had a low risk of bias. Studies showed that microscopic discectomy results in a significantly, but not clinically relevant longer operation time of 12 min (95 % CI 2–22) and shorter incision of 24 mm (95 % CI 7–40) compared with open discectomy, but did not find any clinically relevant superiority of either technique on clinical results. There were conflicting results regarding the comparison of tubular discectomy versus microscopic discectomy for back pain and surgical duration.

Conclusions

Due to the limited amount and quality of evidence, no firm conclusions on effectiveness of the current surgical techniques being open discectomy, microscopic discectomy, and tubular discectomy compared with each other can be drawn. Those differences in leg or back pain scores, operation time, and incision length that were found are clinically insignificant. Large, high-quality studies are needed, which examine not only effectiveness but cost-effectiveness as well.

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Title: Surgical techniques for sciatica due to herniated disc, a systematic review
Authors: Wilco C. H. Jacobs
Mark P. Arts
Maurits W. van Tulder
Sidney M. Rubinstein
Marienke van Middelkoop
Raymond W. Ostelo
Arianne P. Verhagen
Bart W. Koes
Wilco C. Peul
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 11/2012
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-012-2422-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical techniques for sciatica due to herniated disc, a systematic review

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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