Surgical approaches for Sciatica caused by Herniated Disc
Conservative treatment aims to reduce pain and pressure on the nerve root in managing sciatica caused by a herniated disc. However, there is no consensus on the usefulness of surgery without severe neurological deficits.
Surgery may offer faster relief for some patients, but its long-term benefits are uncertain. It is primarily recommended for individuals with slow recovery and significant pain and disability.
Microscopic discectomy is the prevailing surgical procedure for herniated discs. Different methods, such as microscope-assisted and tubular discectomy, have been employed.
Nevertheless, there is ambiguity regarding the relative efficacy of these techniques. Additional research is required to evaluate their advantages and disadvantages.
Evidence of moderate quality indicates a slight decrease in leg pain when comparing microscopic discectomy to open discectomy. However, this reduction is considered clinically insignificant. The evidence regarding back pain, return to work, and operative morbidity is of low quality and lacks consistency.
Conflicting results were observed when comparing tubular discectomy to microscopic discectomy regarding surgical duration and back pain outcomes. Limited data were available for leg pain and other measures.
The choice between open or microscopic discectomy depends on surgeon expertise and available resources rather than clear scientific evidence. New techniques should be tested in controlled trials comparing them to established approaches.
The use of more expensive microsurgical techniques would be justified if they show reduced morbidity with comparable clinical outcomes.
The effectiveness of alternative discectomy methods, such as automated percutaneous and laser discectomy, remains uncertain. Studies suggest that these treatments yield fair or potentially inferior clinical outcomes compared to microscopic discectomy.
Patient selection is acknowledged as an important factor. However, there is a lack of research on intradiscal electrotherapy, coblation, or fusion as treatments for sciatica resulting from disc herniation.
Numerous studies in this review exhibited notable weaknesses in their design. For example, some studies had inadequate sample sizes and failed to conduct proper calculations, thus raising the risk of type II errors.
The quality of randomization and treatment concealment methods was generally subpar. Blinding of surgeons was not feasible given the nature of surgical interventions, and assessments conducted in a blinded manner were frequently lacking. Moreover, only a limited number of studies reported clinical outcomes that met standardized criteria.
It is noteworthy that approximately half of the studies did not include reports on leg pain, which is a significant factor for undergoing surgery. The presence of assessments conducted by the operating surgeon or affiliated individuals introduced the potential for biased evaluation.
Moreover, unclear descriptions and insufficient consideration of code breaks and patient crossovers created a risk of bias in the studies.
In comparison to three reviews published in 2009 that explored different surgical approaches, the systematic review provided by the literature offers dependable and credible outcomes.
The other reviews encountered significant methodological limitations, including conflicts of interest, inadequate pooling techniques, and the inclusion of studies with varied designs, making it challenging to ascertain the true effects of surgery.
Conversely, the authors’ review follows Cochrane methodologies, ensuring high quality by avoiding conflicts of interest. As a result, it generates reliable and valid findings for evaluating the consequences of surgical procedures.
The limited evidence prevents firm conclusions about the comparative effectiveness of open discectomy, microscopic discectomy, and tubular discectomy. The differences in pain scores, operation time, and incision length are clinically insignificant.
Hence, the selection of a surgical technique should prioritize patient and surgeon preferences over specific outcome measures.