Background

The treatment of chronic sciatica caused by herniation of a lumbar disk has not been well studied in comparison with acute disk herniation. Data are needed on whether diskectomy or a conservative approach is better for sciatica that has persisted for several months.

Methods

In a single-center trial, we randomly assigned patients with sciatica that had lasted for 4 to 12 months and lumbar disk herniation at the L4–L5 or L5–S1 level in a 1:1 ratio to undergo microdiskectomy or to receive 6 months of standardized nonoperative care followed by surgery if needed. Surgery was performed by spine surgeons who used conventional microdiskectomy techniques. The primary outcome was the intensity of leg pain on a visual analogue scale (ranging from 0 to 10, with higher scores indicating more severe pain) at 6 months after enrollment. Secondary outcomes were the score on the Oswestry Disability Index, back and leg pain, and quality-of-life scores at 6 weeks, 3 months, 6 months, and 1 year.

Results

From 2010 through 2016, a total of 790 patients were screened; of those patients, 128 were enrolled, with 64 in each group. Among the patients assigned to undergo surgery, the median time from randomization to surgery was 3.1 weeks; of the 64 patients in the nonsurgical group, 22 (34%) crossed over to undergo surgery at a median of 11 months after enrollment. At baseline, the mean score for leg-pain intensity was 7.7 in the surgical group and 8.0 in the nonsurgical group. The primary outcome of the leg-pain intensity score at 6 months was 2.8 in the surgical group and 5.2 in the nonsurgical group (adjusted mean difference, 2.4; 95% confidence interval, 1.4 to 3.4; P<0.001). Secondary outcomes including the score on the Owestry Disability Index and pain at 12 months were in the same direction as the primary outcome. Nine patients had adverse events associated with surgery, and one patient underwent repeat surgery for recurrent disk herniation.

Conclusions

In this single-center trial involving patients with sciatica lasting more than 4 months and caused by lumbar disk herniation, microdiskectomy was superior to nonsurgical care with respect to pain intensity at 6 months of follow-up. (Funded by Physicians’ Services Incorporated Foundation; ClinicalTrials.gov number, NCT01335646.)

QUICK TAKE VIDEO SUMMARY
Treatment Options for Chronic Sciatica
 01:34

中文翻译：

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持续坐骨神经痛持续4到12个月的手术与保守治疗。

背景

与急性椎间盘突出症相比，对腰椎间盘突出症引起的慢性坐骨神经痛的治疗方法尚未得到很好的研究。对于持续数月的坐骨神经痛，需要进行椎间盘切除术或保守治疗是否更好的数据。

方法

在一项单中心试验中，我们将持续4到12个月的坐骨神经痛患者和腰椎间盘突出症以L4–L5或L5–S1水平按1：1比例分配给患者，以进行微盘切除或接受6个月的标准化非手术护理，必要时进行手术。脊柱外科医师采用传统的显微椎间盘切除术进行手术。主要结果是入组后6个月，视觉模拟评分（从0到10，分数越高，表明疼痛越严重）时腿部疼痛的程度。次要结果是Oswestry残疾指数，背部和腿部疼痛以及在6周，3个月，6个月和1年时的生活质量评分。

结果

从2010年到2016年，共筛查了790名患者；在这些患者中，有128名入组，每组64名。在接受手术治疗的患者中，从随机分组到手术的中位时间为3.1周。在非手术组的64例患者中，有22例（34％）在入组后的11个月中值接受了手术。基线时，手术组的腿痛强度平均得分为7.7，非手术组为8.0。手术组在6个月时的腿痛强度评分的主要结局为2.8，而非手术组为5.2（校正后的平均差异为2.4； 95％置信区间为1.4至3.4； P <0.001）。次要结果（包括Owestry残疾指数评分和12个月时的疼痛）与主要结果的方向相同。

结论

在这项由坐骨神经痛患者持续超过4个月且由腰椎间盘突出症引起的坐骨神经痛的单中心试验中，就术后6个月的疼痛强度而言，显微椎间盘切除术优于非手术治疗。（由内科医生服务公司基金会资助； ClinicalTrials.gov编号，NCT01335646。）

快速视频摘要
慢性坐骨神经痛的治疗选择
 01:34