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Early surgery was better than conservative care for short-term disability and pain in sciatica

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W C Peul

Dr W C Peul, Leiden University Medical Centre, Leiden, The Netherlands; w.c.peul@lumc.nl

STUDY DESIGN

Design:

randomised controlled trial.

Allocation:

{concealed}*.†

Blinding:

unblinded.†

STUDY QUESTION

Setting:

9 hospitals in the Netherlands.

Patients:

283 patients 18–65 years of age (mean age 43 y, 66% men) who had 6–12 weeks of sciatica diagnosed by a neurologist, disc herniation with nerve root compression confirmed by magnetic resonance imaging, and pain distribution and neurological disturbances correlated to the same nerve root. Exclusion criteria included cauda-equina syndrome, severe paresis, same complaints within 12 months, and history of spinal surgery, spinal stenosis, deformity, or severe comorbidity.

Intervention:

early surgery (n = 141), which included removal of disc herniation using a unilateral transflaval approach and removal of loose degenerated disc material, or conservative care (n = 142) provided by family …

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