Minimally Invasive Surgery Is Not Superior for Treating Sciatica

Conventional surgery to relieve the excruciating back pain caused by sciatica offers better results than minimally invasive surgery, according to a new study.

Researchers at the Medical Center Haaglanden (The Hague, The Netherlands) conducted a controlled trial that involved 328 patients (18 to 70 years of age) who had persistent leg pain due to lumbar disk herniations, at seven general hospitals in the Netherlands between January 2005 and October 2006. The patients were randomized to a tubular diskectomy group (167 patients) and a conventional microdiskectomy group (161 patients). The primary outcome was functional assessment on the Roland-Morris Disability Questionnaire (RDQ) for sciatica at eight weeks and at one year after randomization. Secondary outcomes were scores on the visual analog scale (VAS) for leg pain and back pain and the patient's self-report of recovery, as measured on a 7-point scale.


The results showed that at eight weeks after surgery, the RDQ mean score was 5.8 for tubular diskectomy and 4.9 for conventional microdiskectomy; at one year, the RDQ mean score was 4.7 for tubular diskectomy and 3.4 for conventional microdiskectomy. On the visual analog scale, the one-year between-group mean difference in improvement was 4.2 mm for leg pain and 3.5 mm for back pain, in favor of conventional microdiskectomy. At one year, 107 of 156 patients (69%) assigned to tubular diskectomy reported a good recovery, compared to 120 of 151 patients (79%) assigned to conventional microdiskectomy. The study was published in the July 8, 2009, issue of the Journal of the American Medical Association (JAMA).

"The reason why minimally invasive surgery did not work could be because our conventional technique uses a small incision as well,” said study author orthopedic surgeon Mark P. Arts, M.D. "Minimally invasive surgery might still be recommended in some cases. We are still working on our subgroup analysis, but possibly the tubular diskectomy is indicated in obese patients in whom a large incision and exposure is inevitable.”

Sciatica (or sciatic neuritis) is a set of symptoms including pain that may be caused by general compression or irritation of one of five nerve roots that give rise to the sciatic nerve, or the sciatic nerve itself. The pain is felt in the lower back, buttock, and various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, pins and needles or tingling and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.

Related Links:
Medical Center Haaglanden