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Microdiscectomy for sciatica: reality check study of long-term surgical treatment effects of a Lumbosacral radicular syndrome (LSRS)

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Abstract

Purpose

It remains unclear whether the long-term results of RCTs regarding the outcome of microdiscectomy for lumbosacral radicular syndrome (LSRS) are generalizable. The purpose of this study was to determine the external validity of the outcome preseneted in RCTs after microdicectomy for LSRS in a patient cohort from a high-volume spine center.

Methods

Between 2007 and 2010, 539 patients had a single level microdiscectomy for MRI disk-related LSRS of whom 246 agreed to participate. Questionnaires included visual analogue scores (VAS) for leg pain, RDQ, OLBD, RAND-36 and Likert scores for recovery, leg and back pain. Lumbar re-operation(s) were registered.

Results

Mean age was 51.3, and median time of follow-up was 8.0 years. Re-operation occurred in 64 (26%) patients. Unfavorable perceived recovery was noted in 85 (35%) patients, and they had worse leg and back pain than the 161 (65%) patients with a favorable recovery: median VAS for leg pain 28/100 mm versus 2/100 mm and median VAS for back pain 9/100 mm versus 3/100 mm, respectively. In addition, the median RDQ and OLBD scores differed significantly: 9 vs 3 for RDQ and 26 vs 4 for OLBD, respectively (p < 0.001).

Conclusion

In this cohort study, the long-term results after microdiscectomy for LSRS were less favorable than those obtained in RCTs, possibly caused by less strict patient selection than in RCTs. Our findings emphasize that patients, who do not meet the same inclusion criteria for surgery as in RCTs, should be informed about the chances of a less favorable result.

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Authors and Affiliations

  1. Department of Neurosurgery, Amsterdam UMC, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands

    Michiel.B. Lequin, Dagmar Verbaan, Peter R. Schuurman, William P. Vandertop & Gerrit J. Bouma

  2. Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands

    Michiel.B. Lequin, Saskia Tasche & Gerrit J. Bouma

  3. Department of Neurosurgery LUMC, University Neurosurgical Center Holland, The Hague, Leiden, The Netherlands

    Wilco C. Peul

Authors
  1. Michiel.B. Lequin
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  2. Dagmar Verbaan
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  3. Peter R. Schuurman
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  4. Saskia Tasche
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  5. Wilco C. Peul
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  6. William P. Vandertop
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  7. Gerrit J. Bouma
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Correspondence to Michiel.B. Lequin.

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Lequin, M., Verbaan, D., Schuurman, P.R. et al. Microdiscectomy for sciatica: reality check study of long-term surgical treatment effects of a Lumbosacral radicular syndrome (LSRS). Eur Spine J 31, 400–407 (2022). https://doi.org/10.1007/s00586-021-07074-x

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  • DOI: https://doi.org/10.1007/s00586-021-07074-x

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