The Operating Theatre Journal - Journal - Page 26
Sciatica surgery pain relief benefits short-lived
Sydney researchers uncover little evidence for lasting relief
A new study has found surgery to reduce leg pain and disability in people with sciatica may not be effective in the long-term.
Surgery to relieve leg pain and disability in some people with sciatica
may be better than other non-surgical treatments, but the short-lived
benefits may last only up to 12 months, according to a new analysis
led by the University of Sydney, Sydney Musculoskeletal Health, and
published in the journal BMJ.
“However, benefits of surgery in improving leg pain diminished
within 12 months. Similarly, surgery improved functional
outcomes but the improvements were short-lived.”
The analysis also found that the certainty of available evidence is low
to very low, prompting the researchers to suggest that surgery might
only be a worthwhile option for people who feel that the rapid relief
outweighs the costs and potential risks associated with surgery.
Sciatica refers to pain that travels along the path of the sciatic nerve,
from the lower back and down the leg. In some people, sciatica occurs
when a “slipped” or herniated disc causes irritation or pressure on the
small roots of the nerve in the back.
Current treatment guidelines recommend surgery known as
discectomy when non-surgical options such as drugs or steroid
injections are unsuccessful. And while surgery is widely used,
evidence for its use is still uncertain.
“Solving this puzzle of why patients have different outcomes
is the key to helping people with sciatica and clinicians choose
the right treatment for them earlier in the disease trajectory,
while being fully informed of the key benefits and risks of
surgery” Professor Christine Lin
Researchers searched databases for randomised controlled trials
comparing any surgical treatment with non-surgical treatment,
epidural steroid injections, or placebo or ‘sham’ surgery, in people
with sciatica of any duration due to a herniated disc.
Trials follow-up times were split into immediate term (six weeks or
less), short term (between six weeks and three months), medium term
(between three months and 12 months), and long term (12 months).
A total of 24 trials were included in the main analysis, of which half
looked at the effectiveness of discectomy compared with non-surgical
treatment or epidural steroid injections.
“Our analysis found that there was low to very-low certainty
evidence of a moderate reduction in leg pain when we
compared surgical to non-surgical treatment,” said lead author
Dr Chang Liu from Sydney Musculoskeletal Health, an initiative of
the University of Sydney, Sydney Local Health District and Northern
Sydney Local Health District.
Inflammation around the discs between vertebrae in the spinal
column can lead to sciatica.
A similar effect on leg pain was also found when comparing
discectomy with epidural steroid injections. The risk of any adverse
events, such as wound infection, repeat disc herniation, and
persistent postsurgical pain, was similar between discectomy and nonsurgical treatment.
They also suggest that the conclusions from this review should be
limited to people with sciatica who have not responded well to nonsurgical approaches, or people who have severe pain and who have a
surgical indication on an MRI scan.
Fortunately, the majority of people with sciatica recover
spontaneously without the need for surgery. However, this also poses
a challenge for healthcare providers as there are no ways to reliably
predict patient outcomes, the researchers note.
“Solving this puzzle of why patients have different outcomes
is the key to helping people with sciatica and clinicians choose
the right treatment for them earlier in the disease trajectory,
while being fully informed of the key benefits and risks of
surgery,” said senior author Professor Christine Lin.
ODP Day/14 May
Advancing the Profession
For this year’s National ODP Day the College of Operating Department Practitioners has made the following
resources available via the following link: https://bit.ly/CODPResources
If you wish to share your event activities with our readers, which we will include in the June issue, please send a
short report along with and images to admin@otjonline.com – The subject heading should please read ‘ ODP Day 23’
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