Transforaminal transforaminal discectomy that is non-inferior to open microdisctectomy. Physician’s Weekly

1. PTED, or percutaneous transforaminal discectomy (PTED) was not superior to open microdiscectomy in the reduction of leg pain.

Evaluation Rating: 1. (Excellent)

Study Summary: Sciatica is a frequent health issue. The most common cause is disc herniation in the lumbar region, sciatica is typically characterized by leg pain radiating from the lower back, occasionally caused by motor or sensory impairments. For the majority of people, sciatica has a favourable natural course. However, if conservative treatment is unsuccessful or progressive neurological problems occur, surgery might be suggested. The procedure that is commonly used to treat the herniation of the lumbar disc is an open microdiscectomy. But, different surgical procedures with less of an invasive are also being developed. One of these methods is called percutaneous transforaminal endoscopic diskectomy (PTED). PTED is believed to cause a less invasive hospitalization speed, quicker recovery and less back pain after surgery since general anesthesia isn’t employed, paraspinal muscles are not dissociated from their insertion points and the bony anatomy has not been altered. This controlled, randomized study was designed to determine if PTED is not superior to traditional open microdiscectomy for the reduction of leg pain due to the herniation of the lumbar disc. The participants included 613 patients between the ages of 18 and 70 who had at minimum six weeks of leg pain due to herniated discs in the lumbar region. Patients were assigned in a one-to-one ratio between PTED and open microdiscectomy. The primary outcome was self-reported leg discomfort assessed by a 0-100 analogue scale after 12 months. After 12 months, patients who were randomly assigned to PTED showed statistically significant lower score on the visual analogue scale of the leg (median 7.0 and interval of 1.0-30.0) as compared to those who were randomized to open microdiscectomy (16.0, 2.0-53.5) (between the two groups, the difference was 7.1 95 95% range of confidence 2.8 between 2.8 and 11.3). The conclusion was that PTED was not superior to open microdiscectomy for the reduction in leg pain.

Here to access the study’s report in the BMJ

Related Readings: Treatment versus conventional treatment for chronic sciatica lasting between 4 and 12 months

In-Depth, [randomized Controlled Study In-Depth [Randomized Controlled Trial]: This study was conducted in five general hospitals across the Netherlands in patients suffering from sciatica due to herniation of the lumbar disc. Patients were considered eligible if they had an appropriate indication to undergo surgery. This translates to at minimum six weeks of severe leg pain radiating outwards, but no evidence of improvement after conservative therapy. Other criteria for inclusion were of between the ages 18 to 70 and confirmation of an injury to the nerve root through the lumbar disc herniation as seen on magnetic imaging, and a sufficient understanding of the Dutch language to fill out forms and follow the instructions. Exclusion criteria were prior surgery performed at the similar or adjacent level of the disc Cauda Equina Syndrome, degenerative or isthmic spondylolisthesis pregnancy, serious medical or mental illness and severe cranial or caudal isolation of fragments from discs the contraindication to surgery and relocating abroad at very short notice. Patients were randomized or PTED and open discectomy. The primary outcome was reduction in the severity of leg pain over one year. This was determined by a visual analogue scale that ranged from 0 to 100, with higher scores suggesting greater pain in the leg. The secondary outcomes were functional status as measured by Oswestry Disability Index, functional status as measured by the Oswestry Disability Index, back pain as well as quality of life. psychological and physical well-being measured by the shorter form of 36 (SF-36) as well as self-perceived improvement from symptoms, healing from leg pain and satisfaction with treatment and improvement in symptoms. Between February 2016 until April 2019 613 patients were included as part of the research. Out of the 304 participants who were randomized to PTED 286 (94 percent) received the treatment. Of the patients randomized to open microdiscectomy 244 (79 percent) were treated with surgery. After 12 months this primary result was present for 532 (87 percent) of the patients randomized. The median scale of visual analogue for leg pain revealed the same increase in the pain of legs for both groups after surgery. For the first three months, the differences in mean reduction of leg pain among the two groups were minimal. At nine, six twelve months and at six, the mean variations in favor of PTED were higher. After 12 months of follow-up, the mean groups in legs pain was 7.1 (95 percent 95% confidence interval 2.8 between 2.8 and 11.3) for PTED. In general, the mean difference in secondary outcomes among the two groups were minimal during the initial three months but increase in favor of PTED at nine, six twelve, and twelve months. These findings suggest that PTED could be considered an alternative to microdiscectomy open when treating sciatica.

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