Monday 01 October 2007, 12:00AM
PEARLS 23, October 2007, written by Brian R
McAvoy
Clinical question
How effective are surgical interventions for lumbar disc
prolapse?
Bottom line
Surgical discectomy for carefully selected patients with
sciatica due to lumbar disc prolapse provides faster relief from
the acute attack than conservative management. However, any
positive or negative effects on the lifetime natural history of the
underlying disc disease are still unclear.
Caveat
Ninety per cent of acute attacks of sciatica settle with
non-surgical management. Microdiscectomy gives broadly comparable
results to open discectomy. The evidence on other minimally
invasive techniques remains unclear.
Context
Prolapsed lumbar discs account for less than 5 per cent
of all low-back problems, but are the most common cause of
sciatica.
Cochrane Systematic Review
Gibson JNA, Waddell G. Surgical interventions for lumbar
disc prolapse. Cochrane Database of Systematic Reviews 2007, Issue
2. Article No. CD001350. DOI: 10.1002/14651858.CD001350.pub4. Note:
This review contains 42 trials involving 5197 participants.