Greater leg pain relief with lumbar microdiscectomy vs nonsurgical treatment for persistent sciatica .
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Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months
N Engl J Med. 2020 Mar 19;382(12):1093-1102.One hundred and twenty-eight patients with persistent sciatica due to lumbar disc herniation were randomized to receive either surgical treatment via lumbar discectomy or standard non-surgical treatment involving education, exercise, physiotherapy, oral analgesics and epidural glucocorticoid injections. The primary outcome of interest was leg pain intensity measured on a numeric rating scale, 6 months post-treatment. Secondary outcomes of interest included back pain, the Oswestry Disability Index (ODI), the Short Form 36 (SF-36) mental and physical component scores (MCS, PCS), employment status and patient satisfaction. Follow up occurred at 6 months and 12 months post-treatment. Results revealed significantly lower leg pain intensity at 6 months in the surgical group compared to the conservative group. Secondary outcomes of interest were not statistically compared, however they trended in favour of the surgical group.
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