Table 1.
Results of RCTs comparing microdiscectomy versus conservative treatment.
| Results | P value; Difference (95% CI) | |
| Leg pain, measured on a 100 mm VAS from 0 = no pain to 100 = worst possible pain | ||
| Baseline | 61 with microdiscectomy v 57 with conservative treatment | NS |
| 6 weeks | 12 with microdiscectomy v 25 with conservative treatment | P less than 0.01 |
| 3 months | 9 with microdiscectomy v 16 with conservative treatment | NS |
| 6 months | 9 with microdiscectomy v 18 with conservative treatment | NS |
| 1 year | 6 with microdiscectomy v 9 with conservative treatment | NS |
| 2 years | 6 with microdiscectomy v 15 with conservative treatment | NS |
| Leg pain, measured on a 100 mm VAS from 0 = no pain to 100 = worst possible pain | ||
| Baseline | 67.2 with early surgery v 64.4 with conservative care | NS |
| 8 weeks | 10.2 with early surgery v 27.9 with conservative care | 17.7 (12.3 to 23.1) |
| 6 months | 8.4 with early surgery v 14.5 with conservative care | 6.1 (2.2 to 10.0) |
| 1 year | 11.0 with early surgery v 11.0 with conservative care | 0 (–4.0 to +4.0) |
| 2 years | 11.0 with early surgery v 9.0 with conservative care | –2 (–6.0 to +2.0) |
| Back pain, measured on a 100 mm VAS from 0 = no pain to 100 = worst possible pain | ||
| Baseline | 53 with microdiscectomy v 47 with conservative treatment | NS |
| 6 weeks | 21 with microdiscectomy v 28 with conservative treatment | NS |
| 3 months | 15 with microdiscectomy v 22 with conservative treatment | NS |
| 6 months | 13 with microdiscectomy v 20 with conservative treatment | NS |
| 1 year | 19 with microdiscectomy v 17 with conservative treatment | NS |
| 2 years | 11 with microdiscectomy v 21 with conservative treatment | NS |
| Back pain, measured on a 100 mm VAS from 0 = no pain to 100 = worst possible pain | ||
| Baseline | 33.8 with early surgery v 30.8 with conservative care | NS |
| 8 weeks | 14.4 with early surgery v 25.7 with conservative care | 11.3 (5.6 to 17.4) |
| 6 months | 15.5 with early surgery v 17.8 with conservative care | +2.3 (–3.6 to +8.2) |
| 1 year | 14.2 with early surgery v 16.5 with conservative care | +2.3 (–3.6 to +8.2) |
| 2 years | 15.9 with early surgery v 17.3 with conservative care | +1.4 (–4.5 to +6.3) |
| Function/disability, Oswestry Low back Pain Disability Score, measured on a scale of 0–100, increasing score indicates greater lower back pain related disability | ||
| Baseline | 39 with microdiscectomy v 39 with conservative treatment | NS |
| 6 weeks | 16 with microdiscectomy v 22 with conservative treatment | NS |
| 3 months | 8 with microdiscectomy v 14 with conservative treatment | NS |
| 6 months | 8 with microdiscectomy v 12 with conservative treatment | NS |
| 1 year | 10 with microdiscectomy v 11 with conservative treatment | NS |
| 2 years | 6 with microdiscectomy v 11 with conservative treatment | NS |
| Function/disability, Modified Roland disability questionnaire, measured on a scale of 0 to 23, increasing score indicates worse functional status | ||
| Baseline | 16.5 with early surgery v 16.3 with conservative care | NS |
| 8 weeks | 6.1 with early surgery v 9.2 with conservative care | 3.1 (1.7 to 4.3) |
| 6 months | 4.0 with early surgery v 4.8 with conservative care | +0.8 (–0.5 to +2.1) |
| 1 year | 3.3 with early surgery v 3.7 with conservative care | +0.4 (–0.9 to +1.7) |
| 2 years | 3.1 with early surgery v 2.6 with conservative care | +0.5 (–0.8 to +1.8) |
| Subjective ability to work, measured on a 100 mm VAS where 0 = unable to work to 100 = best possible work ability | ||
| Baseline | 44 with microdiscectomy v 37 with conservative treatment | NS |
| 6 weeks | 68 with microdiscectomy v 63 with conservative treatment | NS |
| 3 months | 84 with microdiscectomy v 70 with conservative treatment | NS |
| 6 months | 87 with microdiscectomy v 75 with conservative treatment | NS |
| 1 year | 82 with microdiscectomy v 81 with conservative treatment | NS |
| 2 years | 89 with microdiscectomy v 79 with conservative treatment | NS |
| Quality of life, 15-D quality of life score, measured on a scale from 0 to 1.0; increasing score indicates better subjective general health and function | ||
| Baseline | 0.83 with microdiscectomy v 0.84 with conservative treatment | NS |
| 6 weeks | 0.92 with microdiscectomy v 0.89 with conservative treatment | NS |
| 3 months | 0.94 with microdiscectomy v 0.91 with conservative treatment | NS |
| 6 months | 0.95 with microdiscectomy v 0.90 with conservative treatment | NS |
| 1 year | 0.95 with microdiscectomy v 0.94 with conservative treatment | NS |
| 2 years | 0.95 with microdiscectomy v 0.93 with conservative treatment | NS |
| Health status, SF-36 bodily pain questionnaire, measured on a scale from 0 to 100; increasing score indicates less severe symptoms | ||
| Baseline | 21.9 with early surgery v 23.9 with conservative care | NS |
| 8 weeks | 62.8 with early surgery v 54.4 with conservative care | –8.4 (–13.5 to –3.2) |
| 6 months | 76.1 with early surgery v 72.8 with conservative care | –3.3 (–8.4 to +1.8) |
| 1 year | 81.2 with early surgery v 78.5 with conservative care | –2.7 (–7.9 to +2.6) |
| 2 years | 78.4 with early surgery v 80.7 with conservative care | +2.3 (–2.7 to +7.3) |
| Health status, SF-36 physical functioning questionnaire, measured on a scale from 0 to 100; increasing score indicates less severe symptoms | ||
| Baseline | 33.9 with early surgery v 34.6 with conservative care | NS |
| 8 weeks | 71.2 with early surgery v 61.9 with conservative care | –9.3 ( –14.2 to –4.4) |
| 6 months | 79.1 with early surgery v 77.6 with conservative care | –1.5 (–6.4 to +3.4) |
| 1 year | 84.2 with early surgery v 82.0 with conservative care | –2.2 (–7.2 to +2.8) |
| 2 years | 82.3 with early surgery v 83.6 with conservative care | +1.3 (–3.7 to +6.3) |
| Patients’ perceived recovery, % of people with “complete” or “nearly complete” scores on a 7-point Likert scale of global perceived recovery | ||
| Baseline | - | - |
| 8 weeks | 81.2 with early surgery v 36.5 with conservative care | 44.7 (34.2 to 55.0) |
| 6 months | 77.4 with early surgery v 70.8 with conservative care | +6.6 (–3.7 to +17.0) |
| 1 year | 85.7 with early surgery v 82.5 with conservative care | +3.2 (–5.4 to +11.9) |
| 2 years | 81.3 with early surgery v 78.9 with conservative care | +2.4 (–7.2 to +12.0) |
NS, reported as not significant; VAS, visual analogue scale.