Ebook 50 landmark papers every spine surgeon should know: Part 2
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Ebook 50 landmark papers every spine surgeon should know: Part 2
Section Three • DegenerativeChapter 2 1Lumbar Disc Herniation:A Controlled, Prospective study with 10 Years of ObservationWeber H, etal. Spine 1983Rev Ebook 50 landmark papers every spine surgeon should know: Part 2viewed by Raj Gala and Peter G. WhangResearch Question/Objective The type and timing of treatment for lumbar disc herniation remains controversial. The shortcomings of prior studies included concern for information and selection bias, the often retrospective nature of the research, and a lack of dia Ebook 50 landmark papers every spine surgeon should know: Part 2gnostic imaging in the conservatively treated groups. Prior to this study, there was a paucity of randomized controlled trials comparing operative toEbook 50 landmark papers every spine surgeon should know: Part 2
nonoperative management. Throughout previous nonrandomized comparative studies, the reported outcomes were inconsistent, and there was additional unceSection Three • DegenerativeChapter 2 1Lumbar Disc Herniation:A Controlled, Prospective study with 10 Years of ObservationWeber H, etal. Spine 1983Rev Ebook 50 landmark papers every spine surgeon should know: Part 2reliable data surrounding the question of operative versus nonoperative treatment for lumbar disc herniation.Study Design The main research focus (Group 1) was a prospective, randomized, controlled trial comparing surgery and continued physiotherapy for patients with sciatica secondary to an associa Ebook 50 landmark papers every spine surgeon should know: Part 2ted lumbar disc herniation for whom the authors believed there was true equipoise between the two treatments. The study also included two prospectiveEbook 50 landmark papers every spine surgeon should know: Part 2
nonrandomized observational arms: a group of patients who were thought to have definitive indications for surgery (Group 2) and a group of patients whSection Three • DegenerativeChapter 2 1Lumbar Disc Herniation:A Controlled, Prospective study with 10 Years of ObservationWeber H, etal. Spine 1983Rev Ebook 50 landmark papers every spine surgeon should know: Part 2The study included 280 consecutive patients with sciatica secondary to a disc herniation. One hundred twenty-six patients were allocated to Group 1 (age range 25 to 55 years) and randomized to either operative treatment (60 patients) or continued physiotherapy (66 patients). Group 2 consisted of 67 Ebook 50 landmark papers every spine surgeon should know: Part 2patients who were felt to have definitive indications for surgery, and Group 3 included 87 patients who showed continuous improvement during the initiEbook 50 landmark papers every spine surgeon should know: Part 2
al enrollment period and were selected for conservative treatment.109110 Section Three • DegenerativeFollow-Up All patients were sent a questionnaire Section Three • DegenerativeChapter 2 1Lumbar Disc Herniation:A Controlled, Prospective study with 10 Years of ObservationWeber H, etal. Spine 1983Rev Ebook 50 landmark papers every spine surgeon should know: Part 2follow-up. only patients in Group I presented for repeal assessment.Inclusion/Exclusion Criteria The study included 280 consecutive patients who presented with sciatica with clinical symptoms of Ĩ..5 or SI radiculopathy and with corresponding positive findings on radiological investigation (radiculo Ebook 50 landmark papers every spine surgeon should know: Part 2graphy). Patients were excluded if they had spondylolisthesis or prior operations on the spine. Patients were assigned to definitive surgery (Group 2)Ebook 50 landmark papers every spine surgeon should know: Part 2
if they exhibited any of the following findings: severe and immobile scoliosis, intolerable pain, suddenly occurring and/or progressive muscle weakneSection Three • DegenerativeChapter 2 1Lumbar Disc Herniation:A Controlled, Prospective study with 10 Years of ObservationWeber H, etal. Spine 1983Rev Ebook 50 landmark papers every spine surgeon should know: Part 2to continue nonsurgical treatment. The remaining patients (Group I) were randomized to either operative or nonoperative management.Intervention or Treatment Received All patients were initially admitted to the hospital under the Department of Neurology. Patients who did not require immediate surgery Ebook 50 landmark papers every spine surgeon should know: Part 2 underwent a 14-day observation period of bed rest, medication, and progressive physiotherapy. After this regimen, patients in Group 1 were randomizedEbook 50 landmark papers every spine surgeon should know: Part 2
to either surgery or conservative management. The nonoperative patients were transferred to a rehabilitation hospital for an average of 6 weeks of phSection Three • DegenerativeChapter 2 1Lumbar Disc Herniation:A Controlled, Prospective study with 10 Years of ObservationWeber H, etal. Spine 1983Rev Ebook 50 landmark papers every spine surgeon should know: Part 2ral arch above and below the exposed interspace, w ith subsequent nerve root decompression and disc removal. Surgical patients were discharged seven to nine days postoperatively. w ithout further treatment.Results Baseline patient characteristics showed a male to female ratio of 1.4:1. similar to pr Ebook 50 landmark papers every spine surgeon should know: Part 2ior studies. Twenty-nine percent of the patients were found to have psychosocial problems, a comparable rate to the U.S. general population.or the 66Ebook 50 landmark papers every spine surgeon should know: Part 2
patients who were randomized to conservative treatment, 17 crossed over to operative treatment during the first year (range I 11 months), with one patSection Three • DegenerativeChapter 2 1Lumbar Disc Herniation:A Controlled, Prospective study with 10 Years of ObservationWeber H, etal. Spine 1983Rev Ebook 50 landmark papers every spine surgeon should know: Part 2subjective reports made by the patients. Within the intention-to-treat analysis and as-treated analyses, the 1-year results showed statistically better outcomes in the operated group. By the 4-ycar mark, the difference was no longer statistically significant, although there remained a trend toward f Ebook 50 landmark papers every spine surgeon should know: Part 2avorable outcomes in the operated group. At final follow-up at 10 years, there was no observable difference between the two groups. “Good” outcomes weEbook 50 landmark papers every spine surgeon should know: Part 2
re reports in 56% of patients initially assigned to conservative treatment compared to 63.6% of patients initially randomized to surgery, but this wasSection Three • DegenerativeChapter 2 1Lumbar Disc Herniation:A Controlled, Prospective study with 10 Years of ObservationWeber H, etal. Spine 1983Rev Ebook 50 landmark papers every spine surgeon should know: Part 2al CroupOperatedTotalRemained in Original GroupOperatedTotalGood16824271037hair2442818725Poor9413404Bad011000lotal491766491766Adapted from Weiser. H.. spine, 1983.Table 21.2 Operative Treatment GroupResult1-Year Results10-Year ResultsOperated as PlannedNot OperatedTotalOperated as PlannedNot Operate Ebook 50 landmark papers every spine surgeon should know: Part 2dTotalGood3903934135Fair1511616016Poor505404Bad000000Total5916054155Adapted from Weber. H.» spine, 1983.significant difference. Tables 21.1 and 21.2 sEbook 50 landmark papers every spine surgeon should know: Part 2
ummarize the data for the groups undergoing conservative and operative treatments, respectively.Section Three • DegenerativeChapter 2 1Lumbar Disc Herniation:A Controlled, Prospective study with 10 Years of ObservationWeber H, etal. Spine 1983RevSection Three • DegenerativeChapter 2 1Lumbar Disc Herniation:A Controlled, Prospective study with 10 Years of ObservationWeber H, etal. Spine 1983RevGọi ngay
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