Chen BL;Guo JB;Zhang HW;Zhang YJ;Zhu Y;Zhang J;Hu Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis. Clin Rehabil. 2017 Jul 1:269215517719952. doi: 10.1177/0269215517719952.
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OBJECTIVE: To investigate the effects of surgical versus non-operative treatment on the physical function and safety of patients with lumbar disc herniation.

DATA SOURCES: PubMed, Cochrane Library, Embase, EBSCO, Web of Science, China National Knowledge Infrastructure and Chinese Biomedical Literature Database were searched from initiation to 15 May 2017.

METHODS: Randomized controlled trials that evaluated surgical versus non-operative treatment for patients with lumbar disc herniation were selected. The primary outcomes were pain and side-effects. Secondary outcomes were function and health-related quality of life. A random effects model was used to calculate the pooled mean difference with 95% confidence interval.

RESULTS: A total of 19 articles that involved 2272 participants met the inclusion criteria. Compared with non-operative treatment, surgical treatment was more effective in lowering pain (short term: mean difference?=?-0.94, 95% confidence interval?=?-1.87 to -0.00; midterm: mean difference?=?-1.59, 95% confidence interval?=?-2.24 to -9.94), improving function (midterm: mean difference?=?-7.84, 95% confidence interval?=?-14.00 to -1.68; long term: mean difference?=?-12.21, 95% confidence interval?=?-23.90 to -0.52) and quality of life. The 36-item Short-Form Health Survey for physical functions (short term: mean difference?=?6.25, 95% confidence interval?=?0.43 to 12.08) and bodily pain (short term: mean difference?=?5.42, 95% confidence interval?=?0.40 to 10.45) was also utilized. No significant difference was observed in adverse events (mean difference?=?0.82, 95% confidence interval?=?0.28 to 2.38).

CONCLUSION: Low-quality evidence suggested that surgical treatment is more effective than non-operative treatment in improving physical functions; no significant difference was observed in adverse events. No firm recommendation can be made due to instability of the summarized data.

Comments from MORE raters

Nurse rater

This article is a good resource, which has been well documented, and will surely add to the existing orthopaedic burden of knowledge.
Comments from PAIN+ CPN subscribers

Prof. Mike Poling (9/9/2017 8:33 PM)

This is NOT a good source of information for decision making. The term "non-operative management" could be anything-poor physiotherapy with hot packs and TENS (doesn't work), doing nothing, anti-inflammatories (doesn't work), analgesics, narcotics...all of these are typical responses to lower back pain and none of them are effective. Good quality physiotherapy with an evidence based approach, such as a McKenzie/MDT program, is a much better way to compare. The evidence clearly shows that such methods can identify surgical candidates rapidly and effectively as well as prevent many surgical candidates from requiring said surgery.