Our Summary

This research study compared two treatment options for sciatica caused by a herniated lumbar disc: transforaminal epidural steroid injection (TFESI) and surgical microdiscectomy. The study involved 163 patients from 11 spinal units across the UK who had been suffering from sciatica for between 6 weeks and 12 months and had not responded to non-invasive treatment. The patients were randomly assigned to either receive a TFESI or undergo surgery.

The main measure of success was the patients’ scores on the Oswestry Disability Questionnaire (ODQ) at 18 weeks after treatment. The ODQ score measures how much a patient’s condition affects their ability to manage everyday life.

At 18 weeks, the patients in the TFESI group had an average ODQ score of 30.02 while those in the surgery group had an average score of 22.30. This indicates that both groups saw improvement, but the surgery group had slightly better results. However, the difference was not statistically significant.

There were four serious adverse events associated with surgery, while none were associated with TFESI. The cost analysis indicated that surgery was more expensive than TFESI and not as cost-effective.

The researchers concluded that for patients with sciatica due to a herniated lumbar disc, TFESI should be considered as the first invasive treatment option. Surgery does not seem to be a cost-effective alternative to TFESI.

FAQs

  1. What were the two treatment options compared in this research study for sciatica caused by a herniated lumbar disc?
  2. What were the results and implications of the study on treatment options for sciatica?
  3. How did the study measure the success of the two treatment options?

Doctor’s Tip

A doctor might tell a patient considering microdiscectomy that while surgery can provide slightly better results in terms of improving symptoms compared to other treatments like epidural steroid injections, it also comes with potential risks and higher costs. It’s important to weigh the pros and cons of each treatment option and consider factors such as recovery time, potential complications, and overall cost-effectiveness before making a decision. It’s always best to discuss all available options with your doctor to determine the best course of action for your specific situation.

Suitable For

Patients who are typically recommended microdiscectomy are those who have been suffering from sciatica caused by a herniated lumbar disc for between 6 weeks and 12 months and have not responded to non-invasive treatments. These patients may have severe pain, weakness, or numbness in their lower back, buttocks, or legs that significantly impacts their daily life and quality of life. They may also have tried other treatments such as physical therapy, medication, or injections without success. Additionally, patients who are otherwise healthy and able to undergo surgery may be recommended for microdiscectomy.

Timeline

Before microdiscectomy:

  1. Patient experiences sciatica caused by a herniated lumbar disc for 6 weeks to 12 months.
  2. Patient undergoes non-invasive treatment that does not provide relief.
  3. Patient is randomly assigned to receive either a transforaminal epidural steroid injection (TFESI) or undergo surgical microdiscectomy.

After microdiscectomy:

  1. At 18 weeks post-treatment, patient’s Oswestry Disability Questionnaire (ODQ) score is measured.
  2. Patients who underwent microdiscectomy had slightly better ODQ scores compared to those who received TFESI, but the difference was not statistically significant.
  3. Four serious adverse events were associated with surgery, while none were associated with TFESI.
  4. Surgery was found to be more expensive and less cost-effective compared to TFESI.
  5. Researchers recommend TFESI as the first invasive treatment option for patients with sciatica caused by a herniated lumbar disc.

What to Ask Your Doctor

Some questions a patient should ask their doctor about microdiscectomy include:

  1. What are the potential risks and complications associated with microdiscectomy surgery?
  2. How long is the recovery period after microdiscectomy surgery?
  3. What are the expected outcomes and success rates of microdiscectomy for my specific condition?
  4. Are there any alternative treatment options to consider before opting for microdiscectomy?
  5. How experienced are you in performing microdiscectomy procedures?
  6. Will I need physical therapy or rehabilitation after microdiscectomy surgery?
  7. How long can I expect relief from my symptoms after undergoing microdiscectomy?
  8. What can I do to help ensure a successful outcome from microdiscectomy surgery?
  9. Are there any specific lifestyle changes or precautions I should take after microdiscectomy surgery?
  10. How will my pain be managed after microdiscectomy surgery?

Reference

Authors: Wilby MJ, Best A, Wood E, Burnside G, Bedson E, Short H, Wheatley D, Hill-McManus D, Sharma M, Clark S, Baranidharan G, Price C, Mannion R, Hutchinson PJ, Hughes DA, Marson A, Williamson PR. Journal: Lancet Rheumatol. 2021 Mar 18;3(5):e347-e356. doi: 10.1016/S2665-9913(21)00036-9. eCollection 2021 May. PMID: 33969319