title: Improved outcome after lumbar microdiscectomy in patients shown their excised disc fragments: a prospective, double blind, randomised, controlled trial.
abstract: BACKGROUND
  Lumbar microdiscectomy (LMD) is a commonly performed neurosurgical procedure. We set up a prospective, double blind, randomised, controlled trial to test the hypothesis that presenting the removed disc material to patients after LMD improves patient outcome.
  
  
  METHODS
  Adult patients undergoing LMD for radiculopathy caused by a prolapsed intervertebral disc were randomised into one of two groups, termed experimental and control. Patients in the experimental group were given their removed disc fragments whereas patients in the control group were not. Patients were unaware of the trial hypothesis and investigators were blinded to patient group allocation. Outcome was assessed between 3 and 6 months after LMD. Primary outcome measures were the degree of improvement in sciatica and back pain reported by the patients. Secondary outcome measures were the degree of improvement in leg weakness, paraesthesia, numbness, walking distance and use of analgesia reported by the patients.
  
  
  RESULTS
  Data from 38 patients in the experimental group and 36 patients in the control group were analysed. The two groups were matched for age, sex and preoperative symptoms. More patients in the experimental compared with the control group reported improvements in leg pain (91.5 vs 80.4%; p<0.05), back pain (86.1 vs 75.0%; p<0.05), limb weakness (90.5 vs 56.3%; p<0.02), paraesthesia (88 vs 61.9%; p<0.05) and reduced analgesic use (92.1 vs 69.4%; p<0.02) than preoperatively.
  
  
  CONCLUSIONS
  Presentation of excised disc fragments is a cheap and effective way to improve outcome after LMD.
authors.affiliation: Academic Neurosurgery Unit, St George's University of London, London SW17 0RE, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Tait
authors.forename: J
authors.initials: J
authors.lastname: Levy
authors.forename: M
authors.initials: M
authors.lastname: Nowell
authors.forename: C
authors.initials: C
authors.lastname: Pocock
authors.forename: V
authors.initials: V
authors.lastname: Petrik
authors.forename: B A
authors.initials: BA
authors.lastname: Bell
authors.forename: M C
authors.initials: MC
authors.lastname: Papadopoulos
mesh_terms: D000328:Adult; D001416:Back Pain / Q000628:therapy; D017586:Diskectomy / Q000009:adverse effects / Q000523:psychology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000523:psychology; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000523:psychology*; D012585:Sciatica / Q000601:surgery; D016896:Treatment Outcome; D016138:Walking