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

r 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
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Minimally Invasive Surgery Not Better for Sciatica
Minimally Invasive Surgery Not Better for Sciatica
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