Low back and lumbar radicular syndrome: comparative study of the operative and non-operative treatment.

Aim: To compare the effectiveness of the discectomy and conservative treatment in patients with disc related low back and lumbar radicular syndrome.

Methods: We performed retrospective-prospective cohort study enrolling 100 patients. According to our extended criteria all of them had operative indications. We operated 50 patients, 50 patients refused operation and they were treated non-operatively. The following measures of outcome were used: Sciatica Bothersomeness Index, leg and back pain depending on the activity, Lasègue test, contralateral Lasègue test, neurological deficit. Data were assessed at the beginning of the treatment and after 2 months, 7 months, and 18 months.

Results: Treatment results were in favor of surgery for majority of outcome measures as well as for all periods of assessment. After 18 months there was significant difference between operated and non-operated patients related to Sciatica Bothersomeness Index (p less than 0,05), Lasègue test (p=0,002), neurological deficit (p less than 0,05) and leg and back pain depending on the activity (p=0,009). There was no significant difference between the groups related to contralateral Lasègue test (p=0,206).

Conclusion: We expended formerly accepted operative indications. There were better treatment results in the operated group of patients. A fast reduction of symptoms is the main advantage of the operative treatment strategy. Patients whose pain is controlled in a manner that is acceptable for them may decide to postpone surgery. Patients preference for the type of treatment is crucial for an ultimate surgical decision in cases without widespread neurologic deficits.