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Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study

OBJECTIVES: Evidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patie...

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Autores principales: Gugliotta, Marinella, da Costa, Bruno R, Dabis, Essam, Theiler, Robert, Jüni, Peter, Reichenbach, Stephan, Landolt, Hans, Hasler, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223716/
https://www.ncbi.nlm.nih.gov/pubmed/28003290
http://dx.doi.org/10.1136/bmjopen-2016-012938
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author Gugliotta, Marinella
da Costa, Bruno R
Dabis, Essam
Theiler, Robert
Jüni, Peter
Reichenbach, Stephan
Landolt, Hans
Hasler, Paul
author_facet Gugliotta, Marinella
da Costa, Bruno R
Dabis, Essam
Theiler, Robert
Jüni, Peter
Reichenbach, Stephan
Landolt, Hans
Hasler, Paul
author_sort Gugliotta, Marinella
collection PubMed
description OBJECTIVES: Evidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting. METHODS: A prospective cohort study of a routine clinical practice registry consisting of 370 patients. Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life. Primary outcomes were back pain at 6 and 12 weeks. Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks. We filled in missing outcome variable values with multiple imputation, accounted for repeated measures within patients with mixed-effects models and adjusted baseline group differences in relevant prognostic indicators by inverse probability of treatment weighting. RESULTS: Surgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy (−0.97; 95% CI −1.89 to −0.09), were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks (48% vs 17%, risk difference: 0.34; 95% CI 0.16 to 0.47) and reported less physical function disability at 52 weeks (−3.7; 95% CI −7.4 to −0.1). The other assessments showed minimal between-group differences with CIs, including the null effect. CONCLUSIONS: Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up.
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spelling pubmed-52237162017-01-13 Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study Gugliotta, Marinella da Costa, Bruno R Dabis, Essam Theiler, Robert Jüni, Peter Reichenbach, Stephan Landolt, Hans Hasler, Paul BMJ Open Rehabilitation Medicine OBJECTIVES: Evidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting. METHODS: A prospective cohort study of a routine clinical practice registry consisting of 370 patients. Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life. Primary outcomes were back pain at 6 and 12 weeks. Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks. We filled in missing outcome variable values with multiple imputation, accounted for repeated measures within patients with mixed-effects models and adjusted baseline group differences in relevant prognostic indicators by inverse probability of treatment weighting. RESULTS: Surgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy (−0.97; 95% CI −1.89 to −0.09), were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks (48% vs 17%, risk difference: 0.34; 95% CI 0.16 to 0.47) and reported less physical function disability at 52 weeks (−3.7; 95% CI −7.4 to −0.1). The other assessments showed minimal between-group differences with CIs, including the null effect. CONCLUSIONS: Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up. BMJ Publishing Group 2016-12-21 /pmc/articles/PMC5223716/ /pubmed/28003290 http://dx.doi.org/10.1136/bmjopen-2016-012938 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Rehabilitation Medicine
Gugliotta, Marinella
da Costa, Bruno R
Dabis, Essam
Theiler, Robert
Jüni, Peter
Reichenbach, Stephan
Landolt, Hans
Hasler, Paul
Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study
title Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study
title_full Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study
title_fullStr Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study
title_full_unstemmed Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study
title_short Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study
title_sort surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study
topic Rehabilitation Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223716/
https://www.ncbi.nlm.nih.gov/pubmed/28003290
http://dx.doi.org/10.1136/bmjopen-2016-012938
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