caa a22 4500 445833793 CHVBK 20180317145324.0 cr unu---uuuuu 170323e20110401xx s 000 0 eng 10.1007/s00586-010-1603-7 doi (NATIONALLICENCE)springer-10.1007/s00586-010-1603-7 Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review [Elektronische Daten] [Wilco Jacobs, Maurits van Tulder, Mark Arts, Sidney Rubinstein, Marienke van Middelkoop, Raymond Ostelo, Arianne Verhagen, Bart Koes, Wilco Peul] The effectiveness of surgery in patients with sciatica due to lumbar disc herniations is not without dispute. The goal of this study was to assess the effects of surgery versus conservative therapy (including epidural injections) for patients with sciatica due to lumbar disc herniation. A comprehensive search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to October 2009. Randomised controlled trials of adults with lumbar radicular pain, which evaluated at least one clinically relevant outcome measure (pain, functional status, perceived recovery, lost days of work) were included. Two authors assessed risk of bias according to Cochrane criteria and extracted the data. In total, five studies were identified, two of which with a low risk of bias. One study compared early surgery with prolonged conservative care followed by surgery if needed; three studies compared surgery with usual conservative care, and one study compared surgery with epidural injections. Data were not pooled because of clinical heterogeneity and poor reporting of data. One large low-risk-of-bias trial demonstrated that early surgery in patients with 6-12weeks of radicular pain leads to faster pain relief when compared with prolonged conservative treatment, but there were no differences after 1 and 2years. Another large low-risk-of-bias trial between surgery and usual conservative care found no statistically significant differences on any of the primary outcome measures after 1 and 2years. Future studies should evaluate who benefits more from surgery and who from conservative care. The Author(s), 2010 Sciatica nationallicence Conservative treatment nationallicence Surgery nationallicence Discectomy nationallicence Systematic review nationallicence Jacobs Wilco Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands aut van Tulder Maurits Department of Health Sciences, Faculty of Earth and Life Science, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands aut Arts Mark Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2512 VA, The Hague, The Netherlands aut Rubinstein Sidney Department of Epidemiology and Biostatistics, EMGO-Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands aut van Middelkoop Marienke Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut Ostelo Raymond Department of Health Sciences, Faculty of Earth and Life Science, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands aut Verhagen Arianne Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut Koes Bart Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut Peul Wilco Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands aut European Spine Journal Springer-Verlag 20/4(2011-04-01), 513-522 0940-6719 20:4<513 2011 20 586 https://doi.org/10.1007/s00586-010-1603-7 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00586-010-1603-7 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Jacobs Wilco Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands aut NATIONALLICENCE 700 1- van Tulder Maurits Department of Health Sciences, Faculty of Earth and Life Science, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- Arts Mark Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2512 VA, The Hague, The Netherlands aut NATIONALLICENCE 700 1- Rubinstein Sidney Department of Epidemiology and Biostatistics, EMGO-Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- van Middelkoop Marienke Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- Ostelo Raymond Department of Health Sciences, Faculty of Earth and Life Science, EMGO Institute for Health and Care Research, VU University, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- Verhagen Arianne Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- Koes Bart Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- Peul Wilco Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands aut NATIONALLICENCE 773 0- European Spine Journal Springer-Verlag 20/4(2011-04-01), 513-522 0940-6719 20:4<513 2011 20 586 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer