Navigation Links
Minimally Invasive Surgery Not Better for Sciatica
Date:7/7/2009

Faster recovery, less pain with conventional operation

TUESDAY, July 7 (HealthDay News) -- Minimally invasive surgery for the excruciating back pain that can be caused by sciatica didn't work as well as the conventional procedure in a Dutch study.

"The expected treatment benefit of a faster rate of recovery from sciatica after tubular diskectomy could not be reproduced by this double-blind study," according to a report in the July 8 issue of the Journal of the American Medical Association.

Orthopedic surgeons at the Medical Center Haaglanden studied 328 people who underwent surgery for sciatic pain, and found that "the overall differences in pain intensity and recovery rates favored the conventional microdiskectomy."

Surgery is done to remove the portion of a disk that has ruptured and causes pain by pressing on the sciatic nerve. The older method, microdiskectomy, is done through a larger incision than that used for transmuscular tubular diskectomy, the minimally invasive technique that was introduced in 1997 and has gained wide popularity. But only a few studies comparing results of the two techniques have been reported.

"The reason why it [minimally invasive surgery] did not work could be because our conventional technique uses a small incision as well," said study author Dr. Mark P. Arts.

Minimally invasive surgery might still be recommended in some cases, Arts noted. "We are still working on our subgroup analysis, but possibly the tubular diskectomy is indicated in obese patients in whom a large incision and exposure is inevitable," he said.

But more patients probably will prefer the conventional approach, Arts said. "We will discuss the results of our study with our patients and their prejudiced opinion of small being better will probably change into, 'Do what's best for me,'" he said.

The results of the Dutch study were no surprise to Dr. Todd J. Albert, director of the department of orthopedic surgery at the Rothman Institute of Thomas Jefferson University in Philadelphia.

"We have people in our unit who did a similar study and found very similar results," Albert said. That study has been submitted to a medical journal for publication, he noted.

Any minimally invasive surgical technique is bound to be popular "because the public wants a less invasive procedure if it accomplishes the same thing," Albert said. "Sometimes it pans out and sometimes it doesn't. With knee surgery it has, but minimally invasive hip surgery, which was a big rage a few years ago, is not necessarily better."

In his practice, Albert said, surgery for sciatic pain is done with a procedure halfway between the conventional and minimally invasive methods. "Maybe my incision is a half a centimeter longer than for microdiskectomy," he said. "We find the window where the disk is pressing on the nerve and push it out. It is much more like the open-surgery approach."

In practical terms, the real question about surgery for sciatica is not which technique should be used but whether surgery should be done, said Dr. Michael Y. Wang, an associate professor of neurological surgery and rehabilitation medicine at the University of Miami Miller School of Medicine.

"In general, the answer is, when you have a neurological deficit or intractable pain or a problem threatening loss in terms of neurological function," Wang said. The most common reason is to ease pain, he said.

The differences shown in the Dutch study are not great enough to say that one procedure is clearly preferable over the other, Wang noted. "I use the conventional technique even though I'm a minimally invasive surgeon," he said. "For sciatica, the minimally invasive method is too complicated and involved."

The Dutch results are not directly transferable to the United States for several reasons, Wang said. For example, those who had surgery in the study stayed an average of 3.3 days in the hospital. Such a long stay is virtually unheard of in the United States, where hospital discharge is almost always done a day or two after surgery, Wang said.

More information

Sciatica and its treatment are described by the U.S. National Library of Medicine.



SOURCES: Mark P. Arts, M.D., neurosurgeon, Medical Center Haaglanden, the Hague, Netherlands; Todd J. Albert, M.D., director, department of orthopedic surgery, Rothman Institute of Thomas Jefferson University, Philadelphia; Michael Y. Yang, M.D., associate professor, neurological surgery and rehabilitation medicine, University of Miami Miller School of Medicine; July 8, 2009, Journal of the American Medical Association


'/>"/>
Copyright©2009 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Minimally Invasive Heart Surgery Research Wins N.I.H. Award
2. Novadaq launches PINPOINT: Companys first minimally invasive imaging system
3. Published Results Using AtriCure Minimally Invasive Products
4. Awake the Movie Highlights the Need for Goldilocks Anesthesia, Says Dr. Barry L. Friedberg, Developer of Bispectral Index (BIS) Monitored Propofol Ketamine Sedation, Now Trademarked as Minimally Invasive Anesthesia (MIA)(R)
5. Z-shaped incision enhances minimally-invasive surgery
6. Z-shaped incision enhances minimally invasive surgery
7. Minimally Invasive Surgery Fixes Aneurysms
8. Northwestern Memorials Heart Center Pioneers Minimally Invasive Surgery That Corrects Irregular Heart Beat
9. Minimally invasive fibroid treatment fares well in multicenter trial
10. Women Can Now Learn About Minimally Invasive Gynecologic Treatments at AAGL.org
11. Robot-assisted minimally-invasive CABG surgery
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Minimally Invasive Surgery Not Better for Sciatica
(Date:3/24/2017)... ... March 24, 2017 , ... Digital Scientists, a software ... announce the opening of a Greenville, South Carolina location. The lab has ... in Greenville. , “We’ve been working with South Carolina clients for years from our ...
(Date:3/24/2017)... ... March 24, 2017 , ... ... related services to families and business owners across eastern Michigan, is connecting with ... families struggling with financial difficulties. , The Oxford/Orion FISH Food Pantry works to ...
(Date:3/24/2017)... , ... March 24, 2017 , ... ... panels at the Advanced ERISA Benefit Claims Litigation seminar in Chicago, Illinois. ... Administrative Record, The majority of cases litigated under ERISA involve claims for long-term ...
(Date:3/24/2017)... ... 24, 2017 , ... Judy Buchanan, co-owner of Serenity Natural ... Judy says, “I am passionate about sharing Reiki as a holistic, complementary therapy ... challenging time.” , A Certified Medical Reiki™ Master trained by Raven Keys Medical ...
(Date:3/24/2017)... ... 2017 , ... “The Adventures of Joey, The Dog Who Barks at Puddles”: ... life to the fullest, as God intended. “The Adventures of Joey, The Dog Who ... grandmother pursuing her passion for writing, especially about truth and human behavior. , Published ...
Breaking Medicine News(10 mins):
(Date:3/24/2017)... , Mar. 24, 2017 Research and Markets has ... Development, Growth and Demand Forecast to 2022" report to their offering. ... The global wound care ... grow at a CAGR of 6.7% during 2016-2022 Among the ... the largest share in the global market in 2015. Among the various ...
(Date:3/24/2017)... Research and Markets has announced the addition of the "Dental Implants ... ... for Dental Implants in US$ Million. The report provides separate comprehensive analytics ... , Europe , Asia-Pacific , ... Annual estimates and forecasts are provided for the period 2015 through 2022. ...
(Date:3/24/2017)... , March 24, 2017 ... providing high-quality and cost-effective drug development and ... pharmaceutical and biotechnology industry, announced today the ... ShangPharma will be consolidating the Contract ... (CMO) under Shanghai ChemPartner. These entities include ...
Breaking Medicine Technology: