Sciatica Research Today is a free monthly online journal that collates and summarizes the latest research about Sciatica, including details on treatment, prevention, medication.

Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; design of a prospective randomized controlled trial.

Brouwer PA, Peul WC, Brand R, Arts MP, Koes BW, van den Berg AA, van Buchem MA

Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. p.a.brouwer@lumc.nl

BACKGROUND: The usual surgical treatment of refractory sciatica caused by lumbar disc herniation, is open discectomy. Minimally invasive procedures, including percutaneous therapies under local anesthesia, are increasingly gaining attention. One of these treatments is Percutaneous Laser Disc Decompression (PLDD). This treatment can be carried out in an outpatient setting and swift recovery and return to daily routine are suggested. Thus far, no randomized trial into cost-effectiveness of PLDD versus standard surgical procedure has been performed. We present the design of a randomized controlled trial, studying the cost-effectiveness of PLDD versus conventional open discectomy in patients with sciatica from lumbar disc herniation. METHODS/DESIGN: The study is a randomized prospective multi-center trial, in which two treatment strategies are compared in a parallel group design. Patients (age 18-70 years) visiting the neurosurgery department of the participating hospitals, are considered for inclusion in the trial when sciatica due to lumbar disc herniation has lasted more than 8 weeks. Patients with disc herniation smaller than 1/3 of the spinal canal diameter, without concomitant lateral recess stenosis or sequestration, are eligible for participation, and are randomized into one of two treatment arms; either Percutaneous Laser Disc Decompression or conventional discectomy. The functional outcome of the patient, as assessed by the Roland Disability Questionnaire for Sciatica at 8 weeks and 1 year after treatment, is the primary outcome measure. The secondary outcome parameters are recovery as perceived by the patient, leg and back pain, incidence of re-intervention, complications, quality of life, medical consumption, absence of work and secondary costs. DISCUSSION: Open discectomy is still considered to be the golden standard in the surgical treatment of lumbar disc herniation. Whether Percutaneous Laser Disc Decompression has at least as much efficacy as the standard surgical procedure, and is more cost-effective, will be determined by this trial.

Published 17 June 2009 in BMC Musculoskelet Disord, 10: 49.
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Articles on Sciatica published 16 June 2009:

Piriformis syndrome, diagnosis and treatment.   Muscle Nerve, 40(1): 10-18.

Piriformis syndrome (PS) is an uncommon cause of sciatica that involves buttock pain referred to the leg. Diagnosis is often difficult, and it is one of exclusion due to few validated and standardized diagnostic tests. Treatment for PS has historically focused on stretching and physical therapy modalities, with refractory patients also receiving anesthetic and corticosteroid injections into the piriformis muscle origin, belly, muscle sheath, or sciatic nerve sheath. Recently, the use of ... [Abstract] [Full-text]

Articles on Sciatica published 15 June 2009:

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Articles on Sciatica published 8 June 2009:

Neuroanatomical basis of acupuncture treatment for some common illnesses.   Acupunct Med, 27(2): 61-4.

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Articles on Sciatica published 2 June 2009:

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Articles on Sciatica published 1 June 2009:

Neurogenic muscle hypertrophy.   Joint Bone Spine.

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Articles on Sciatica published 29 May 2009:

Giant extradural sacral meningioma.   Acta Neurochir (Wien).

We present the first case of primary benign fibrous meningioma restricted to the sacrum with no sign of recurrence after a long follow-up duration. This occurred in a 36-year-old man who initially presented with a 3-month history of right-sided sciatica. The tumour was successfully resected after three surgical procedures due to its high vascularity and technical difficulties. Sacroiliac joint stability was not disrupted, and he is still doing well clinically at 8 years follow-up. [Abstract] [Full-text]

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