[Early surgery or a wait-and-see policy in lumbosacral radicular syndrome: a randomized study].
OBJECTIVE
To compare early surgery with expectative policy and later surgery if necessary in patients with sciatica that did not resolve within 6 weeks.


METHODS
Randomized multicentre clinical trial (ISRCTN 26872154).


METHODS
Patients who had had severe sciatica for 6 to 12 weeks were randomized to early surgery or to prolonged conservative treatment with later surgery if necessary. The primary outcomes were the Roland Disability Questionnaire score, the visual-analogue scale for leg pain score, and the patient's report of their perceived recovery over the first year after randomization. Repeated measures analysis according to the intention-to-treat principle was used to analyse the outcome curves for both groups.


RESULTS
A total of 283 patients were included and randomized. Of 141 patients assigned to undergo early surgery, 125 (89%) underwent microdiscectomy after a mean of 2.2 weeks. Of 142 patients assigned to conservative treatment, 55 (39%) still had to undergo surgical treatment after a mean of 18.7 weeks. There was no significant overall difference in disability scores during the first year (p = 0.13). Leg pain lessened more quickly in patients assigned to early surgery (p < 0.001). Patients assigned to early surgery also reported a faster rate of perceived recovery (hazard ratio (HR): 1.97; 95% CI: 1.72-2.22; p < 0.001). In both groups, however, the probability of perceived recovery after 1 year of follow-up was 95%.


CONCLUSIONS
The 1-year outcomes were similar for patients assigned to early surgery and those assigned to extended conservative treatment with later surgery if necessary but the rates of reduction of leg pain and of perceived recovery were faster in those assigned to early surgery.
Leids Universitair Medisch Centrum, Postbus 9600, 2300 RC Leiden. w.c.peul@lumc.nl
W C
WC
Peul
H C
HC
Van Houwelingen
W B
WB
Van den Hout
R
R
Brand
J A H
JA
Eekhof
J T J
JT
Tans
R T W M
RT
Thomeer
B W
BW
Koes
D000328:Adult; D019540:Area Under Curve; D004185:Disability Evaluation; D017586:Diskectomy; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery* / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012585:Sciatica / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome