Table 5.
Results of the included studies: Surgery, including epidural injections, versus conservative care
| References | Group | Cross-over | Pain | Recovery | Good outcome | Qualitative short term | Qualitative long term |
|---|---|---|---|---|---|---|---|
| Buttermann [2] | Epidural steroid injection | At 3 years: 58% | VAS leg pain [mean (SD)] (Inferred from graph) | NR | Successful treatment | Greater decrease in leg pain at 3 and 6 months for microdiscectomy | No differences at 1, 2 and 3 years for leg pain |
| At 2–3 years: 8 (12) | Various: 42–56% | ||||||
| Microdiscectomy | At 3 years: 4% | At 2–3 years: 15 (17) | NR | Various: 92–98% | |||
| Osterman [12] | Conservative care | At 2 years: 39% | VAS Leg pain [ITT, mean (SD)]: | Recovered (number/total) | VAS Satisfaction | More rapid relief of leg pain at 6 weeks | No differences at 2 years leg pain, back pain and disability |
| At 1 year: 9 (19) | At 6 weeks: 0/26 | At 1 year: 85 (20) | |||||
| At 1 year 5/21 | |||||||
| Microdiscectomy | At 2 years: 0% | At 1 year: 6 (11) | At 6 weeks: 5/26 | At 1 year: 89 (20) | |||
| At 1 year: 7/20 | |||||||
| Peul [13] | Prolonged conservative care | At 1 year: 39% | VAS leg pain [ITT, mean (SE)]: | Time to recovery | Likert (ITT, mean (SE)) | Better pain relief at 3 months for early surgery. No difference in disability. Faster time to recovery for early surgery | No differences at 1 and 2 years for recovery |
| At 8 weeks: 27.9 (1.9) | 12.1 weeks | At 8 weeks: 3.1 (0.1) | |||||
| At 1 year: 11.0 (1.9) | At 1 year: 2.1 (0.1) | ||||||
| Early surgery | At 1 year: 11% | At 8 weeks: 10.2 (1.9) | 4.0 weeks | At 8 weeks: 2.2 (0.1) | |||
| At 1 year: 11.0 (1.9) | At 1 year: 1.9 (0.1) | ||||||
| Weinstein [22] | Conservative care | At 1 year: 41% | SF 36 pain [mean (SE)]: | NR | SRP (% (SE)): | - | No differences at 2 years on any outcome parameters |
| At 2 years: 45% | At 1 year: 36.9 (1.8) | At 1 year: 66.7 (3.2) | |||||
| At 2 years: 37.1 (1.9) | At 2 years: 69.3 (3.3) | ||||||
| Surgery | At 1 year: 57% | At 1 years: 39.7 (1.8) | NR | At 1 year: 75.7 (3.0) | |||
| At 2 years: 40% | At 2 years: 40.3 (1.9) | At 2 years: 76.3 (3.1) | |||||
| Weber [19] | Usual conservative care | Constant; 26% | No pain (ITT, No pain/total): | NR | SRP (ITT, % good): | Better patient and observer ratings at 1 year for discectomy | No differences at 4 and 10 years |
| At 4 years: 45/66 | At 1 year: 36% | ||||||
| At 10 years: 65/66 | At 4 year: 52% | ||||||
| At 10 year: 56% | |||||||
| Surgery | Constant; 2% | At 4 years: 45/57 | NR | At 1 year: 65% | |||
| At 10 years: 54/55 | At 4 year: 70% | ||||||
| At 10 year: 64% |
ITT intention to treat, NR not reported, VAS visual analogue scale (in 100 mm, unless otherwise specified), SD standard deviation, SE standard error, SRP self rated progress, Likert Likert score for global perception of recovery