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  Zanko J Med Sci:  Dec. 2016; 20 (3): 1405-1410

Surgery versus prolonged conservative treatment for sciatica associated with lumbar disc herniation

Injam Ibrahim Sulaiman*, Sherwan Hamawandi**, Emad K. Hammood*, Ali H. Muhammad Al-Tameemi***

* Department of Neurosurgical, College of Medicine, Hawler Medical University, Erbil, Iraq.

** Department of Orthopedic, College of Medicine, Hawler Medical University, Erbil, Iraq.

*** University of California, San Diego (UCSD), USA.


Background and objective: There is little information available on comparing conservative versus immediate surgery results in the long run for patients with lumbar disc herniation in the modern clinical practice. The aim of this study was to assess one-year outcomes of patients with sciatica resulting from a lumbar disc herniation treated surgically versus non-surgically in two hospitals in Erbil

Methods: A prospective comparative cohort study was conducted over two years (January 2010 to February 2012). A sample 100 patients, 50 treated surgically and 50 conservatively, were followed up for one year. All participants had baseline interviews with follow-up questionnaires filled in the next specially designed follow up visits along the study time at regular intervals of 2, 8, 28 and 52 weeks. The outcome included patient-reported symptoms of leg and back pain, functional status, satisfaction versus expectation and working capacity after treatment or overall disability degree.

Results: Change in the modified Roland back-specific functional status scale favored surgical treatment initially, and the relative benefit decreased but persisted over the follow-up period. Despite these differences, work and disability status at one year were comparable among those treated surgically or non-surgically.

Conclusion: Surgically treated patients with a herniated lumbar disc had more complete relief of leg pain and improved function and satisfaction compared with non-surgically treated patients over one year. Nevertheless, improvement in the patient's predominant symptom and work and disability outcomes were closely similar regardless of treatment received.

Keywords: Herniated lumbar disc; Sciatica; Outcome research; Lumbar discectomy; Conservative management.


1. Frymoyer JW. Back pain and sciatica. N Engl J Med 1988; 318:291–300.

2. Andersson GBJ, Brown MD, Dvorak J. Consensus summary on the diagnosis and treatment of lumbar disc herniation. Spine 1996; 24(suppl): 75–8.

3. Keller RB, Atlas SJ, Soule DN. Relationship between rates and outcomes of operative treatment for lumbar disc herniation and spinal stenosis. J Bone Joint Surg Am 1999; 81:752–62.

4. Weber H. Lumbar disc herniation: a controlled, prospective study with ten years of observation. Spine 1983; 8:131–40.

5. Cherkin DC, Deyo RA, Loeser JD, Bush T, Waddell G. An international comparison of back surgery rates. Spine 1994; 19:1201-6.

6. Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine (Phila Pa 1976) 2008; 33:2464–72.

7. Legrand E, Bouvard B, Audran M, Fournier D, Valat JP. Sciatica from disk herniation: medical treatment or surgery? Joint Bone Spine2007; 74:530–5.

8. Vroomen PC, Krom MC, Slofstra PD, Knottnerus JA. Conservative treatment of sciatica: a systematic review. J Spinal Disord 2000; 13:463–9.

9. Weber H, Holme I, Amlie E. The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. Spine (Phila Pa 1976) 1993; 18:1433–8.

10. Gibson JNA, Waddell G. Surgical interventions for lumbar disc prolapse. Cochrane Database of Systematic Reviews 2007.2.

11. Gregory DS, Seto CK, Wortley GC, Shugart CM. Acute lumbar disk pain: navigating evaluation and treatment choices. Am Fam Physician 2008; 78:835–42.

12. Wilco J, Mauritsvan T, Mark A, Sidney R, Marienke M, Raymond O, et al. Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J 2011; 20(4):513–22.

13. Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB. Assessing healthrelated quality of life in patients with sciatica. Spine1995; 20:1899–908.

14. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 1997; 72:95–7.

15. Peul WC, van Houwelingen HC, van der Hout WB. Prolonged conservative treatment or ‘early’ surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial. BMC Musculoskelet Disord 2005; 6:8.

16. Weber H. Lumbar disc herniation: a controlled, prospective study with ten years of observation. Spine1983; 8:131–40.

17. Wilco C. Peul M, Hans C. Surgery versus Prolonged Conservative Treatment for Sciatica. N Engl J Med 2007; 356:22.

18. Lequin MB, Verbaan D, Jacobs WCH, Ronald B, Vandertop G, William P, et al. Surgery versus prolong conservative treatment of sciatica: 5-year results of randomized controlled trial. BMJ Open 2013; 3:e002534.

19. Greenberg S., Arredondo N. Handbook of Neurosurgery 2006. 6.

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