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Clin Rehabil. 2018 Feb;32(2):146-160. doi: 10.1177/0269215517719952. Epub 2017 Jul 17.

Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis.

Author information

1
1 Department of Rehabilitation, The 2nd Jiangsu Province Hospital of TCM, The 2nd Affiliated Hospital of Nanjing University of TCM, Jiangsu, China.
2
2 Shanghai University of Sport, Shanghai, China.
3
3 Shaoxing Rehabilitation Hospital, Affiliated Hospital of Shaoxing University, Shaoxing, China.
4
4 Sports College, Shaoxing University, Shaoxing, China.
5
5 Hainan Provincial Nongken General Hospital, Haikou, China.
6
6 Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.

Abstract

OBJECTIVE:

To investigate the effects of surgical versus non-operative treatment on the physical function and safety of patients with lumbar disc herniation.

DATA SOURCES:

PubMed, Cochrane Library, Embase, EBSCO, Web of Science, China National Knowledge Infrastructure and Chinese Biomedical Literature Database were searched from initiation to 15 May 2017.

METHODS:

Randomized controlled trials that evaluated surgical versus non-operative treatment for patients with lumbar disc herniation were selected. The primary outcomes were pain and side-effects. Secondary outcomes were function and health-related quality of life. A random effects model was used to calculate the pooled mean difference with 95% confidence interval.

RESULTS:

A total of 19 articles that involved 2272 participants met the inclusion criteria. Compared with non-operative treatment, surgical treatment was more effective in lowering pain (short term: mean difference = -0.94, 95% confidence interval = -1.87 to -0.00; midterm: mean difference = -1.59, 95% confidence interval = -2.24 to -9.94), improving function (midterm: mean difference = -7.84, 95% confidence interval = -14.00 to -1.68; long term: mean difference = -12.21, 95% confidence interval = -23.90 to -0.52) and quality of life. The 36-item Short-Form Health Survey for physical functions (short term: mean difference = 6.25, 95% confidence interval = 0.43 to 12.08) and bodily pain (short term: mean difference = 5.42, 95% confidence interval = 0.40 to 10.45) was also utilized. No significant difference was observed in adverse events (mean difference = 0.82, 95% confidence interval = 0.28 to 2.38).

CONCLUSION:

Low-quality evidence suggested that surgical treatment is more effective than non-operative treatment in improving physical functions; no significant difference was observed in adverse events. No firm recommendation can be made due to instability of the summarized data.

KEYWORDS:

Surgical treatment; lumbar disc herniation; meta-analysis; non-operative treatment; systematic review

PMID:
28715939
DOI:
10.1177/0269215517719952
[Indexed for MEDLINE]

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