Review of Surgical Results for Lumbar Disc HerniationMany studies are published each year on the results of treatment for low back pain. Surgery for lumbar disc prolapse is one of these operations. In this review, two well-known back experts review current data on this treatment. They analyzed and compiled the results of 40 randomized controlled trials (RCTs) and two other semi-RCT studies.
Patients were grouped according to how long they had their symptoms. There were three groups included. Group one had symptoms less than six weeks. Group two had symptoms six weeks to six months. Group three had symptoms longer than six months.
Results from disc removal by any method were measured by recovery, pain level, and function. Function was measured using various scales of disability or quality of life. Return to work and number of further operations were also recorded.
Comparing results was limited because many studies did not include the same information. For this reason, results had to be interpreted carefully. Whenever possible, the authors compared surgery with conservative (nonoperative) care. Various methods of disc removal (discectomy) were compared.
The different types of discectomy included laser, microendoscopic, open, and percutaneous. The use of chymopapain is no longer available so the studies available were presented as a historical summary.
The authors report that all things considered, most lumbar disc prolapses resolve on their own without any treatment. For patients with severe sciatica, discectomy provides rapid relief of symptoms. It's still unknown when is the best time to have surgery.
Whether a microdiscectomy or standard disc removal is better may depend on the surgeons' expertise. Overall it appears the results are about the same. Laser discectomy and coblation therapy are still viewed as research tools. Despite the large number of studies on the topic, more studies with a specific focus on treatment of disc herniation are needed.
The authors suggest the quality of studies needs to be improved. Longer follow-up of patients is advised. There should be a comparison of patients who have surgery with those who don't have surgery.
Records should be kept to measure the cost of the procedure and compare it to the benefit obtained. Different operations could then be compared against each other both in terms of cost and effectiveness.
J. N. Alastair Gibson, MD, FRCS, and Gordon Waddell, DSc, MD, FRCS. Surgical Interventions for Lumbar Disc Prolapse. In Spine. July 15, 2007. Vol. 32. No. 16. Pp. 1735-1747.
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