NEJM: Microvertebral discexcisectomy is better than conservative treatment in improving persistent lumbar disc protrusion sciatic nerve pain

Compared with acute disc protrusion, the treatment regimen for chronic sciatic nerve pain caused by lumbar disc protrusion has not been effectively evaluated, and researchers recently compared the effects of intervertebral disc excision or conservative treatment on sciatic nerve pain that lasted for monthssciatic nerve pain lasts 4-12 months, and patients with L4-L5 or L5-S1 segment disc protrusion were involved in the study, and randomly received microvertebral disc excision or 6 months of standardized non-surgical careThe main result of the study was leg pain intensity (ranging from 0 to 10) for 6 months after admission (the higher the score indicates the more severe the pain)The secondary results were six weeks, three months, six months and one year with the Osswestry Disability Index, lower back and leg pain, and quality of life scores128 patients in the study, 64 in each groupThe median time for surgical treatment was 3.1 weeks from randomized grouping to surgeryOf the 64 non-surgical patients, 22 (34%) underwent surgery after entering the group, for an average of 11 monthsAt the baseline check, the average score for leg pain intensity in the surgical group was 7.7 points and that of the non-surgical group was 8.0 pointsAt 6 months, the main results of the leg pain intensity score in the surgical and non-surgical groups were 2.8 and 5.2 points, respectively (the adjusted average difference was 2.4 points)Secondary results, including the Owestry Disability Index score and 12 months of pain, tended to be consistent with the main resultsNine patients had adverse surgical-related events, and one patient underwent repeated surgery due to recurrent disc protrusionstudies have shown that for patients with lumbar disc protrusion nerve pain that lasts more than 4 months, receiving microvertebral disc excision is more effective in pain relief than conservative therapy