Timing and minimal access surgery for sciatica: a summary of two randomized trials

Excerpt

Sciatica, better defined as sciatic neuralgia or lumbosacral radicular syndrome (LSRS), is a frequently diagnosed debilitating spine disorder with an estimated yearly incidence of 5–10 per 1,000 persons [22]. The societal impact of low back-related disorders is quite high, as they remain the number one cause of work disability in most Western countries. Sciatica manifests itself as radiating dermatome pain regularly accompanied by diminished jerk reflexes, sensory and motor deficits. The most common cause is a herniated lumbar disc, sometimes combined with bony involvement, compressing an exiting nerve root. Less often the radicular pain is caused by a diabetic neuritis, poly-radiculoneuropathy, or tumor. Although lumbar disc surgery is frequently performed, the timing of this intervention and the preferred technique were until recently important points for debate. The performed numbers of low-back surgeries vary widely between and even within countries and the used intervention techniques do seem to be based on personal or societal preferences instead of evidence-based medicine [10]. Currently, scientific study results have been added to medical knowledge making rational approaches for optimal spine care possible. …