Review compares surgeries for sciatica due to herniated disc

(HealthDay)—No conclusions can be drawn with regard to the comparative efficacy of open, microscopic, and tubular discectomy surgical techniques to treat sciatica due to a herniated disc, according to the results of a systematic literature review published in the November issue of the European Spine Journal.

Wilco C.H. Jacobs, M.D., of the Leiden University Medical Center in the Netherlands, and colleagues conducted a systematic literature review on the effect of surgical techniques for sciatica due to disc herniation to update the Cochrane review of 2007. Sixteen studies were included: seven from the original review and nine additional studies, of which four had a low risk of bias.

Compared with open discectomy, the researchers found that microscopic discectomy resulted in a statistically but not clinically significant longer operation time of 12 minutes and shorter incision of 24 mm. There was no clinically relevant superiority of either technique. The results comparing tubular discectomy and microscopic discectomy for back pain and surgical duration were conflicting.

"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," the authors write. "Therefore, the surgical strategy in the treatment of lumbar disc herniation should be based on preferences of patients and surgeons rather [than] outcome measures."