Minimally Invasive Surgery Not Better for Sciatica

Faster recovery, less pain with conventional operation

By Ed Edelson
HealthDay Reporter

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TUESDAY, July 7 (HealthDay News) -- Minimally invasive surgery for the excruciating back pain that can be caused by sciatica didn't work as well as the conventional procedure in a Dutch study.

"The expected treatment benefit of a faster rate of recovery from sciatica after tubular diskectomy could not be reproduced by this double-blind study," according to a report in the July 8 issue of the Journal of the American Medical Association.

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Orthopedic surgeons at the Medical Center Haaglanden studied 328 people who underwent surgery for sciatic pain, and found that "the overall differences in pain intensity and recovery rates favored the conventional microdiskectomy."

Surgery is done to remove the portion of a disk that has ruptured and causes pain by pressing on the sciatic nerve. The older method, microdiskectomy, is done through a larger incision than that used for transmuscular tubular diskectomy, the minimally invasive technique that was introduced in 1997 and has gained wide popularity. But only a few studies comparing results of the two techniques have been reported.

"The reason why it [minimally invasive surgery] did not work could be because our conventional technique uses a small incision as well," said study author Dr. Mark P. Arts.

Minimally invasive surgery might still be recommended in some cases, Arts noted. "We are still working on our subgroup analysis, but possibly the tubular diskectomy is indicated in obese patients in whom a large incision and exposure is inevitable," he said.

But more patients probably will prefer the conventional approach, Arts said. "We will discuss the results of our study with our patients and their prejudiced opinion of small being better will probably change into, 'Do what's best for me,'" he said.

The results of the Dutch study were no surprise to Dr. Todd J. Albert, director of the department of orthopedic surgery at the Rothman Institute of Thomas Jefferson University in Philadelphia.

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