Review Article

European Spine Journal

, Volume 21, Issue 11, pp 2232-2251

Open Access This content is freely available online to anyone, anywhere at any time.

Surgical techniques for sciatica due to herniated disc, a systematic review

  • Wilco C. H. JacobsAffiliated withDepartment of Neurosurgery, Leiden University Medical Center Email author 
  • , Mark P. ArtsAffiliated withDepartment of Neurosurgery, Medical Center Haaglanden
  • , Maurits W. van TulderAffiliated withDepartment of Health Sciences, Faculty of Earth and Life Science & EMGO Institute for Health and Care Research, VU UniversityDepartment of Epidemiology and Biostatistics, EMGO-Institute for Health and Care Research, VU University Medical Center
  • , Sidney M. RubinsteinAffiliated withDepartment of Epidemiology and Biostatistics, EMGO-Institute for Health and Care Research, VU University Medical Center
  • , Marienke van MiddelkoopAffiliated withDepartment of General Practice, Erasmus MC, University Medical Center Rotterdam
  • , Raymond W. OsteloAffiliated withDepartment of Health Sciences, Faculty of Earth and Life Science & EMGO Institute for Health and Care Research, VU UniversityDepartment of Epidemiology and Biostatistics, EMGO-Institute for Health and Care Research, VU University Medical Center
  • , Arianne P. VerhagenAffiliated withDepartment of General Practice, Erasmus MC, University Medical Center Rotterdam
  • , Bart W. KoesAffiliated withDepartment of General Practice, Erasmus MC, University Medical Center Rotterdam
  • , Wilco C. PeulAffiliated withDepartment of Neurosurgery, Leiden University Medical CenterDepartment of Neurosurgery, Medical Center Haaglanden

Abstract

Introduction

Disc herniation with sciatica accounts for five percent of low-back disorders but is one of the most common reasons for spine surgery. The goal of this study was to update the Cochrane review on the effect of surgical techniques for sciatica due to disc herniation, which was last updated in 2007.

Materials and methods

In April 2011, we conducted a comprehensive search in CENTRAL, MEDLINE, EMBASE, CINAHL, PEDRO, ICL, and trial registries. We also checked the reference lists and citation tracking results of each retrieved article. Only randomized controlled trials (RCT) of the surgical management of sciatica due to disc herniation were included. Comparisons including chemonucleolysis and prevention of scar tissue or comparisons against conservative treatment were excluded. Two review authors independently selected studies, assessed risk of bias of the studies and extracted data. Quality of evidence was graded according to the GRADE approach.

Results

Seven studies from the original Cochrane review were included and nine additional studies were found. In total, 16 studies were included, of which four had a low risk of bias. Studies showed that microscopic discectomy results in a significantly, but not clinically relevant longer operation time of 12 min (95 % CI 2–22) and shorter incision of 24 mm (95 % CI 7–40) compared with open discectomy, but did not find any clinically relevant superiority of either technique on clinical results. There were conflicting results regarding the comparison of tubular discectomy versus microscopic discectomy for back pain and surgical duration.

Conclusions

Due to the limited amount and quality of evidence, no firm conclusions on effectiveness of the current surgical techniques being open discectomy, microscopic discectomy, and tubular discectomy compared with each other can be drawn. Those differences in leg or back pain scores, operation time, and incision length that were found are clinically insignificant. Large, high-quality studies are needed, which examine not only effectiveness but cost-effectiveness as well.

Keywords

Herniated disc Sciatica Surgery Discectomy Systematic review