Percutaneous transforaminal endoscopic discectomy effective for Sciatica

Percutaneous transforaminal endoscopic discectomy (PTED) can be considered as an effective alternative to open microdiscectomy in treating sciatica, according to the latest research published in BMJ.

Sciatica is a common health problem in the general population, with a lifetime prevalence of up to 43%. Sciatica is characterized by radiating leg pain starting from the low back, at times accompanied by sensory or motor deficits, and most frequently caused by lumbar disc herniation. Sciatica has a favorable natural course in most people; however, surgery may be indicated if conservative treatment fails or progressive neurological deficits develop. The study conducted by Dutch researchers tried to assess whether percutaneous transforaminal endoscopic discectomy (PTED) is non-inferior to conventional open microdiscectomy in reduction of leg pain caused by lumbar disc herniation.

In the trial, 613 patients aged 18-70 years with at least six weeks of radiating leg pain caused by lumbar disc herniation. The trial included a predetermined set of 125 patients receiving PTED who were the learning curve cases performed by surgeons who did not do PTED before the trial.

The primary outcome was self-reported leg pain measured by a 0-100 visual analog scale at 12 months, assuming a non-inferiority margin of 5.0. Secondary outcomes included complications, reoperations, self-reported functional status as measured with the Oswestry Disability Index, the visual analog scale for back pain, health-related quality of life, and self-perceived recovery. Outcomes were measured until one year after surgery and were longitudinally analyzed according to the intention-to-treat principle. Patients belonging to the PTED learning curve were omitted from the primary analyses.