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J Gen Intern Med. 2019 Nov 11. doi: 10.1007/s11606-019-05476-8. [Epub ahead of print]

Surgical Management of Lumbar Radiculopathy: a Systematic Review.

Author information

1
RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, P.O. Box 12194, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA.
2
RTI International, Research Triangle Park, NC, USA.
3
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
4
RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, P.O. Box 12194, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA. lkahwati@rti.org.
5
RTI International, Research Triangle Park, NC, USA. lkahwati@rti.org.

Abstract

BACKGROUND:

Lumbar radiculopathy is characterized by radiating pain with or without motor weakness or sensory disturbances; the point prevalence ranges from 1.6 to 13.4%. The objective of this review was to determine the efficacy, safety, and cost of surgical versus nonsurgical management of symptomatic lumbar radiculopathy in adults.

METHODS:

We searched PubMed from January 1, 2007, to April 10, 2019 with hand searches of systematic reviews for studies prior to 2007. One reviewer extracted data and a second checked for accuracy. Two reviewers completed independent risk of bias and strength of evidence ratings.

RESULTS:

We included seven RCTs (N = 1158) and three cost-effectiveness analysis. Surgery reduced leg pain by 6 to 26 points more than nonsurgical interventions as measured on a 0- to 100-point visual analog scale of pain at up to 26 weeks follow-up; differences between groups did not persist at 1 year or later. The evidence was somewhat mixed for function and disability in follow-up through 26 weeks (standardized mean difference [SMD] - 0.16 (95% CI, - 0.30 to - 0.03); minimal differences were observed at 2 years (SMD - 0.06 (95% CI, - 0.20 to 0.07). There were similar improvements in quality of life, neurologic symptoms, and return to work. No surgical deaths occurred and surgical morbidity was infrequent. The incidence of reoperations ranged from 0 to 10%. The average cost per quality-adjusted life year gained from a healthcare payor perspective ranged from $51,156 to $83,322 for surgery compared to nonsurgical interventions.

DISCUSSION:

Most findings are based on a body of RCT evidence graded as low to very low certainty. Compared with nonsurgical interventions, surgery probably reduces pain and improves function in the short- and medium-term, but this difference does not persist in the long-term. Although surgery appears to be safe, it may or may not be cost-effective depending on a decision maker's willingness to pay threshold.

KEYWORDS:

disc herniation; discectomy; lumbar radiculopathy; sciatica

PMID:
31713029
DOI:
10.1007/s11606-019-05476-8

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