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Cochrane Database of Systematic Reviews

Surgical interventions for lumbar disc prolapse

Overview of attention for article published in this source, April 2007
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Surgical interventions for lumbar disc prolapse
Published by
John Wiley & Sons, Ltd, April 2007
DOI 10.1002/14651858.cd001350.pub4
Pubmed ID

Gibson, JN Alastair, Waddell, Gordon


Disc prolapse accounts for five percent of low-back disorders but is one of the most common reasons for surgery. The objective of this review was to assess the effects of surgical interventions for the treatment of lumbar disc prolapse. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Spine and abstracts of the main spine society meetings within the last five years. We also checked the reference lists of each retrieved articles and corresponded with experts. All data found up to 1 January 2007 are included. Randomized trials (RCT) and quasi-randomized trials (QRCT) of the surgical management of lumbar disc prolapse. Two review authors assessed trial quality and extracted data from published papers. Additional information was sought from the authors if necessary. Forty RCTs and two QRCTs were identified, including 17 new trials since the first edition of this review in 1999. Many of the early trials were of some form of chemonucleolysis, whereas the majority of the later studies either compared different techniques of discectomy or the use of some form of membrane to reduce epidural scarring. Despite the critical importance of knowing whether surgery is beneficial for disc prolapse, only four trials have directly compared discectomy with conservative management and these give suggestive rather than conclusive results. However, other trials show that discectomy produces better clinical outcomes than chemonucleolysis and that in turn is better than placebo. Microdiscectomy gives broadly comparable results to standard discectomy. Recent trials of an inter-position gel covering the dura (five trials) and of fat (four trials) show that they can reduce scar formation, though there is limited evidence about the effect on clinical outcomes. There is insufficient evidence on other percutaneous discectomy techniques to draw firm conclusions. Three small RCTs of laser discectomy do not provide conclusive evidence on its efficacy, There are no published RCTs of coblation therapy or trans-foraminal endoscopic discectomy. Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. Microdiscectomy gives broadly comparable results to open discectomy. The evidence on other minimally invasive techniques remains unclear (with the exception of chemonucleolysis using chymopapain, which is no longer widely available).

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Geographical breakdown

Country Count As %
Switzerland 1 <1%
Chile 1 <1%
Austria 1 <1%
United Kingdom 1 <1%
China 1 <1%
United States 1 <1%
Lebanon 1 <1%
Unknown 199 97%

Demographic breakdown

Readers by professional status Count As %
Student > Master 36 17%
Researcher 30 15%
Student > Bachelor 23 11%
Other 21 10%
Student > Postgraduate 13 6%
Other 34 17%
Unknown 49 24%
Readers by discipline Count As %
Medicine and Dentistry 88 43%
Nursing and Health Professions 13 6%
Agricultural and Biological Sciences 9 4%
Biochemistry, Genetics and Molecular Biology 5 2%
Business, Management and Accounting 4 2%
Other 28 14%
Unknown 59 29%