Management of sciatica due to lumbar disc herniation in the Netherlands: a survey among spine surgeons

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  • 1 Department of Neurosurgery, Leiden University Medical Center, Leiden;
  • | 2 Department of Neurosurgery, Medical Center Haaglanden, The Hague; and
  • | 3 Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
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Object

Although clinical guidelines for sciatica have been developed, various aspects of lumbar disc herniation remain unclear, and daily clinical practice may vary. The authors conducted a descriptive survey among spine surgeons in the Netherlands to obtain an overview of routine management of lumbar disc herniation.

Methods

One hundred thirty-one spine surgeons were sent a questionnaire regarding various aspects of different surgical procedures. Eighty-six (70%) of the 122 who performed lumbar disc surgery provided usable questionnaires.

Results

Unilateral transflaval discectomy was the most frequently performed procedure and was expected to be the most effective, whereas percutaneous laser disc decompression was expected to be the least effective. Bilateral discectomy was expected to be associated with the most postoperative low-back pain. Recurrent disc herniation was expected to be lowest after bilateral discectomy and highest after percutaneous laser disc decompression. Complications were expected to be highest after bilateral discectomy and lowest after unilateral transflaval discectomy. Nearly half of the surgeons preferentially treated patients with 8–12 weeks of disabling leg pain. Some consensus was shown on acute surgery in patients with short-lasting drop foot and those with a cauda equina syndrome, and nonsurgical treatment in patients with long-lasting, painless drop foot. Most respondents allowed postoperative mobilization within 24 hours but advised their patients not to resume work until 8–12 weeks postoperatively.

Conclusions

Unilateral transflaval discectomy was the most frequently performed procedure. Minimally invasive techniques were expected to be less effective, with higher recurrence rates but less postoperative low-back pain. Variety was shown between surgeons in the management of patients with neurological deficit. Most responding surgeons allowed early mobilization but appeared to give conservative advice in resumption of work.

Abbreviations used in this paper:

MED = microendoscopic discectomy; PLDD = percutaneous laser disc decompression.

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Contributor Notes

Address correspondence to: Mark P. Arts, M.D., Department of Neurosurgery, Medical Center Haaglanden, Westeinde, PO Box 432, 2501 CK The Hague, The Netherlands. email: m.arts@mchaaglanden.nl.
  • 1

    Andersson GB, , Brown MD, , Dvorak J, , Herzog RJ, , Kambin P, & Malter A, et al. : Consensus summary of the diagnosis and treatment of lumbar disc herniation. Spine 21:24 Suppl 75S78S, 1996

    • Search Google Scholar
    • Export Citation
  • 2

    Arts MP, & Kloet A: Het caudasyndroom. Tijd Neurol en Neurochirurg 104:297303, 2003

  • 3

    Arts MP, , Peul WC, , Brand R, , Koes BW, & Thomeer RT: Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN 51857546.]. BMC Musculoskelet Disord 7:42, 2006

    • Search Google Scholar
    • Export Citation
  • 4

    Barth M, , Weiss C, & Thomé C: Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine 33:265272, 2008

    • Search Google Scholar
    • Export Citation
  • 5

    Carragee EJ, , Han MY, , Yang B, , Kim DH, , Kraemer H, & Billys J: Activity restrictions after posterior lumbar discectomy. A prospective study of outcomes in 152 cases with no postoperative restrictions. Spine 24:23462351, 1999

    • Search Google Scholar
    • Export Citation
  • 6

    Carragee EJ, , Spinnickie AO, , Alamin TF, & Paragioudakis S: A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine 31:653657, 2006

    • Search Google Scholar
    • Export Citation
  • 7

    Caspar W: A new surgical procedure for lumbar disk herniation causing less tissue damage through a microsurgical approach. Adv Neurosurg 4:7480, 1977

    • Search Google Scholar
    • Export Citation
  • 8

    Cherkin DC, , Deyo RA, , Loeser JD, , Bush T, & Waddell G: An international comparison of back surgery rates. Spine 19:12011206, 1994

  • 9

    Dubourg G, , Rozenberg S, , Fautrel B, , Valls-Bellec I, , Bissery A, & Lang T, et al. : A pilot study on the recovery from paresis after lumbar disc herniation. Spine 27:14261431, 2002

    • Search Google Scholar
    • Export Citation
  • 10

    Gibson J, & Waddell G: Surgical interventions for lumbar disc pro-lapse. Cochrane Database Syst Rev 1:CD001350, 2007

  • 11

    Gleave JR, & Macfarlane R: Cauda equina syndrome: what is the relationship between timing of surgery and outcome?. Br J Neurosurg 16:325328, 2002

    • Search Google Scholar
    • Export Citation
  • 12

    Health Council of The Netherlands: Management of Lumbosacral Radicular Syndrome (sciatica) The Hague, publication no. 1999/18

  • 13

    Luijsterburg PA, , Verhagen AP, , Braak S, , Avezaat CJ, & Koes BW: Do neurosurgeons subscribe to the guideline lumbosacral radicular syndrome?. Clin Neurol Neurosurg 106:313317, 2004

    • Search Google Scholar
    • Export Citation
  • 14

    Luijsterburg PA, , Verhagen AP, , Braak S, , Oemraw A, , Avezaat CJ, & Koes BW: Neurosurgeons' management of lumbosacral radicular syndrome evaluated against a clinical guideline. Eur Spine J 13:719723, 2004

    • Search Google Scholar
    • Export Citation
  • 15

    McGregor AH, , Dicken B, & Jamrozik K: National audit of post-operative management in spinal surgery. BMC Musculoskelet Disord 7:47, 2006

  • 16

    Mixter WJ, & Barr JS: Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 211:210215, 1934

  • 17

    Myrseth E: [Atypical sciatica. Decreasing pain and increasing paresis—a serious sign.]. Tidsskr Nor Laegeforen 114:26092610, 1994. (Norwegian)

    • Search Google Scholar
    • Export Citation
  • 18

    Ostelo RW, , de Vet HC, , Waddell G, , Kerckhoffs MR, , Leffers P, & van Tulder M: Rehabilitation following first-time lumbar disc surgery: a systematic review within the framework of the cochrane collaboration. Spine 28:209218, 2003

    • Search Google Scholar
    • Export Citation
  • 19

    Osterman H, , Seitsalo S, , Karppinen J, & Malmivaara A: Effectiveness of microdiscectomy for lumbar disc herniation: a randomized controlled trial with 2 years of follow-up. Spine 31:24092414, 2006

    • Search Google Scholar
    • Export Citation
  • 20

    Peul WC, , van Houwelingen HC, , van den Hout WB, , Brand R, , Eekhof JA, & Tans JT, et al. : Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 356:22452256, 2007

    • Search Google Scholar
    • Export Citation
  • 21

    Sandvoss G, , Meyer F, & Feldmann H: [Aneuralgic root paralyses caused by lumbar intervertebral disk displacement. Follow-up of surgical therapy.]. Zentralbl Neurochir 51:98101, 1990. (Ger)

    • Search Google Scholar
    • Export Citation
  • 22

    Stam J: [Consensus on diagnosis and treatment of the lumbosacral radicular syndrome. Dutch Society for Neurology.]. Ned Tijdschr Geneeskd 140:26212627, 1996. (Dutch)

    • Search Google Scholar
    • Export Citation
  • 23

    Thomé C, , Barth M, , Scharf J, & Schmiedek P: Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine 2:271278, 2005

    • Search Google Scholar
    • Export Citation
  • 24

    Weinstein JN, , Tosteson TD, , Lurie JD, , Tosteson AN, , Hanscom B, & Skinner JS, et al. : Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA 296:24412450, 2006

    • Search Google Scholar
    • Export Citation
  • 25

    Yaşargil MG: Microsurgical operation for herniated disc. Adv Neurosurg 7:8182, 1977

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