Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.

Gugliotta, Marinella; Da Costa, Bruno R; Dabis, Essam; Theiler, Robert; Jüni, Peter; Reichenbach, Stephan; Landolt, Hans; Hasler, Paul (2016). Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ open, 6(12), e012938. BMJ Publishing Group 10.1136/bmjopen-2016-012938

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OBJECTIVES Evidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting. METHODS A prospective cohort study of a routine clinical practice registry consisting of 370 patients. Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life. Primary outcomes were back pain at 6 and 12 weeks. Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks. We filled in missing outcome variable values with multiple imputation, accounted for repeated measures within patients with mixed-effects models and adjusted baseline group differences in relevant prognostic indicators by inverse probability of treatment weighting. RESULTS Surgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy (-0.97; 95% CI -1.89 to -0.09), were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks (48% vs 17%, risk difference: 0.34; 95% CI 0.16 to 0.47) and reported less physical function disability at 52 weeks (-3.7; 95% CI -7.4 to -0.1). The other assessments showed minimal between-group differences with CIs, including the null effect. CONCLUSIONS Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology, Clinical Immunology and Allergology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Da Costa, Bruno and Reichenbach, Stephan

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

2044-6055

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

30 Dec 2016 14:01

Last Modified:

05 Jan 2017 10:15

Publisher DOI:

10.1136/bmjopen-2016-012938

PubMed ID:

28003290

Uncontrolled Keywords:

SURGERY conservative hernia prolapse sciatica

BORIS DOI:

10.7892/boris.92321

URI:

https://boris.unibe.ch/id/eprint/92321

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