Low Back Pain and Sciatica
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Low Back Pain and Sciatica and Diskectomy

Written by sshowalter.

Effect of Diskectomy on Low Back Pain and Sciatica

A diskectomy is the removal of the protruding disc and part of the backbone and is done to potentially cure some of the pain associated with sciatica. The doctor makes an incision in the back, then a small part of the bone is removed to obtain access to the disc. The disc is then removed to take pressure off the nerve.

In certain cases, the doctor can perform a microdiskectomy to remove a herniated disc. A microdiskectomy is a less invasive procedure. The doctor makes a smaller incision and uses a magnifying instrument to visualize the disc and nerves. However, it is not always possible to do a microdiskectomy.

Read more details about Diskectomy.

Research Evidence on Diskectomy

In a randomized clinical trial patients with radicular pain and image-confirmed lumbar intervertebral disc herniation were assigned standard diskectomy or a variety of nonoperative treatments. Over two years, both groups showed substantial improvements. Some secondary outcome analyses favored surgical treatment. There were study limitations that could have influenced the outcome.

A clinical trial published in 2007 by Peul, et al., studies early versus delayed microdiskectomy. Patients with severe sciatica were randomly assigned to receive early microdiskectomy (within an average of 2.2 weeks) or conservative treatment (ie, combination of rest, physical therapy, and medications) with delayed surgery if necessary. Although after one year there was no difference in pain or disability between the two groups, those patients receiving early surgery reported significantly faster recovery. However, of the patients who were in the delayed group, only 39% eventually required surgery.

Several studies have attempted to look at the effects of surgical diskectomy versus nonoperative treatments (for example, lifestyle changes, dietary changes, and herbal substances to lower inflammation). Many of these studies find that patients improve with either surgical or nonoperative care. Over time, results may be similar for either group, and while there is a trend suggesting that patients improve faster with surgery, the studies have imperfections that limit direct comparison of surgery versus nonoperative treatment.

References

Bhagia SM. Slipman CW. Nirschl M. Isaac Z. El-Abd O. Sharps LS. Garvin C. Side effects and complications after percutaneous disc decompression using coblation technology. American Journal of Physical Medicine & Rehabilitation . 85(1):6-13, 2006 Jan.

Bridwell KH. Anderson PA. Boden SD. Vaccaro AR. Wang JC. What's new in spine surgery. Journal of Bone & Joint Surgery - American Volume. 90(7):1609-19, 2008 Jul.

Cohen SP. Williams S. Kurihara C. Griffith S. Larkin TM. Nucleoplasty with or without intradiscal electrothermal therapy (IDET) as a treatment for lumbar herniated disc. Journal of Spinal Disorders & Techniques . 18 Suppl:S119-24, 2005 Feb.

Conn's Current Therapy 2001. 53rd ed. WB Saunders Company; 2001.

Pain. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.n... . Accessed October 27, 2008.

Sciatica. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00351 . Accessed October 27, 2008.

Textbook of Primary Care Medicine. 3rd ed. Mosby, Inc.; 2001.

Updated Disketomy section on 6/7/2007 according to the following study, as cited by http://www.ebscohost.com/dynamed/what.php : Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245-2256.

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA . 2006;296:2441–50.

Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA . 2006;296:2451–9.

Zindrick MR. Tzermiadianos MN. Voronov LI. Lorenz M. Hadjipavlou A. An evidence-based medicine approach in determining factors that may affect outcome in lumbar total disc replacement. Spine . 33(11):1262-9, 2008 May 15.

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