PainRelief.com Interview with:
Dr. Chris Bailey
Western Bone and Joint Institute
PainRelief.com: What is the background for this study?
Response: Acute and subacute sciatica from a lumbar disc herniation is recognized to have a very good natural history with approximately 90% making significant improvement within 4 months of onset. Hence, studies have shown that surgery for disc herniation has a short-term benefit over non-operative care.
In many cases, the patients not receiving surgery will improve to the level of those receiving surgery by 6 months (Peul et al, 2007). Chronic sciatica we felt was a different situation.
What are the main findings?
Response: Our study confirmed that surgery has a greater advantage for these patients out to 1 year following surgery. An unpublished stat from our work found that there is a 70% greater chance of significant improvement in sciatica with surgery compared to non-operative care (including physiotherapy, education, medications, and epidural injections). We recommend that a referral is made to a surgeon for these patients as the likelihood of improvement without surgery is much less than for acute sciatic.
PainRelief.com: What should readers take away from your report?
Response: Previous studies have also had a difficult time controlling for cross-over and maintaining distinct treatment cohorts. Our study was designed in such a way to utilized the inherent wait times for consultation in our Canadian health care system so to prevent crossover from the non-op group to the surgical group.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: Our plan is to perform future cost effectiveness analysis and publish on long term outcomes as well.
Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months
Chris S. Bailey, M.D., Parham Rasoulinejad, M.D., David Taylor, M.D., Keith Sequeira, M.D., Thomas Miller, M.D., Jim Watson, M.D., Richard Rosedale, P.T., Stewart I. Bailey, M.D., Kevin R. Gurr, M.D., Fawaz Siddiqi, M.D., Andrew Glennie, M.D., and Jennifer C. Urquhart, Ph.D
Nengl j med 382;12 nejm.org March 19, 2020
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