SPINE
Timing of surgery for sciatica: Subgroup analysis alongside a randomized trial
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(5):74 Eur Spine J. 2009 Apr;18(4):538-45. Epub 2009 Jan 9Exclusive Author Interview
Surgical timing and its effect on clinical outcomes of sciatica with Dr. Peul
283 patients suffering from sciatica, identified by radiological confirmation of expected disc herniation, were either randomized to a prolonged conservative treatment (delayed surgical intervention if necessary) or to an early surgical intervention. The results indicated that conservative treatment produced similar results as the early surgical intervention at one year. This study also performed a secondary analysis of different subgroups within the patient population to identify determinants of recovery time in both procedures. The analysis identified sciatic pain upon sitting, as an indicator for early surgical intervention.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Sciatica is typically treated by two methods: either an early surgical intervention or a conservative treatment, followed by surgery if necessary. This study has initially provided evidence that a conservative treatment results in similar functional recovery at 1 year; however, it required more time compared to the early surgical intervention. This study aimed to define the exact determinants that predict recovery rates in the two treatment methods.
主な研究課題は何ですか？
Are there any anamnestic, neurological, or radiological variables that influence the rate of recovery between an early surgical treatment versus a conservative treatment?
重要な知見は？
- Patients with sciatica pain, provoked by sitting, were shown to have slower rates of recovery when randomized to prolonged conservative treatment (p = 0.07)
- There was a 2.2 hazard ratio (95% CI 1.7 to 3.0) in favor of the early surgical procedure in patients with sciatica pain, provoked by sitting; while in patients without the pain provoked by sitting, the hazard ratio was only 1.3 (95% CI 0.8 to 2.2), in favor of early surgical intervention
- The RDQ and VAS scores over the first year showed significant differences between early surgery and conservative treatment when stratified for sciatic provoked by siting (P= 0.05 and 0.03, respectively). For sciatica not provoked by siting early surgery showed less favourable results.
- There were no differences observed in other subgroup analyses including age, job demands, history of back pain and difficulty to put on shoes
- No interaction between classical neurological tests on speed of recovery was seen. Treatment preference did not influence any of the outcomes either.
最も覚えておくべきことは？
The only variable this study identifies as an indication for early surgery, providing the quickest recovery, is sciatica pain that is provoked by sitting.
それが私の患者ケアにどのように影響するか？
Patients with sciatica that have pain provoked by sitting may have improved clinical outcomes with early surgical intervention as opposed to conservative therapy. Larger trials need to investigate if conservative treatment is a better option for sciatica provoked by other means.
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