Prolonged conservative treatment or early surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial ISRCT 26872154Reportar como inadecuado

Prolonged conservative treatment or early surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial ISRCT 26872154 - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Musculoskeletal Disorders

, 6:8

First Online: 11 February 2005Received: 10 January 2005Accepted: 11 February 2005


BackgroundThe design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica lumbosacral radicular syndrome.

Methods-designPatients presenting themselves to their general practitioner with disabling sciatica lasting less than twelve weeks are referred to the neurology outpatient department of one of the participating hospitals. After confirmation of the diagnosis and surgical indication MRI scanning is performed. If a distinct disc herniation is discerned which in addition covers the clinically expected site the patient is eligible for randomization. Depending on the outcome of the randomization scheme the patient will either be submitted to prolonged conservative care or surgery. Surgery will be carried out according to the guidelines and between six and twelve weeks after onset of complaints. The experimental therapy consists of a prolonged conservative treatment under supervision of the general practitioner, which may be followed by surgical intervention in case of persisting or progressive disability. The main primary outcome measure is the disease specific disability of daily functioning. Other primary outcome measures are perceived recovery and intensity of legpain. Secondary outcome measures encompass severity of complaints, quality of life, medical consumption, absenteeism, costs and preference. The main research question will be answered at 12 months after randomization. The total follow-up period covers two years.

DiscussionEvidence is lacking concerning the optimal treatment of lumbar disc induced sciatica. This pragmatic randomized trial, focusses on the -timing- of intervention, and will contribute to the decision of the general practictioner and neurologist, regarding referral of patients for surgery.

AbbreviationsGPGeneral Practitioner

LSRSLumbosacral Radicular Syndrome

RCTRandomized Controlled Trial

VASVisual Analogue Scale

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-6-8 contains supplementary material, which is available to authorized users.

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Autor: Wilco C Peul - Hans C van Houwelingen - Wilbert B van der Hout - Ronald Brand - Just AH Eekhof - Joseph ThJ Tans - Ralp


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