Evidence map›Paper›PMID 17443505›Full record

SynthesisThe Cochrane database of systematic reviews2007

Surgical interventions for lumbar disc prolapse.

J N A Gibson, G Waddell

Registry-linked trialOpen access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Cochrane database of systematic reviews, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03137485 (Management of Lumbar Postero-lateral Single Level Disc Herniation), which is not on this map. Cited by 44 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
44citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03137485 nacompletednot on this mapstarted 2016, after this paper: background citation

Management of Lumbar Postero-lateral Single Level Disc Herniation: Comparative Study Between Conventional and Endoscopic Lumbar Discectomy

TypeinterventionalSponsorAssiut UniversityRan2016 to 2018Enrolled30ConditionsLumbar Disc HerniationArmsConventional open lumbar discectomy, Percutaneous Endoscopic Translaminar lumbar discectomy., Easy Go system Endoscopy
3 · Its place in the literature

Who cites it

44 citing papers in PubMed, 8 syntheses or guidelines pooled it, 170 citations in OpenAlex.

  1. Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2016
    Pooled it
  2. A meta-analysis of endoscopic discectomy versus open discectomy for symptomatic lumbar disk herniation.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2016
    Pooled it
  3. Pooled it
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  5. Systematic review of microendoscopic discectomy for lumbar disc herniation.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2013
    Pooled it
  6. Surgical techniques for sciatica due to herniated disc, a systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2012
    Pooled it
  7. Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2011
    Pooled it
  8. Injection therapy and denervation procedures for chronic low-back pain: a systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2010
    Pooled it
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  11. A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2017
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

2 authors at 2 institutions in 2 countries.

J N A GibsonRoyal Infirmary of Edinburgh, Lothian University Hospitals NHS Trust, Little France, Edinburgh, UK EH16 4SU. j.n.a.gibson@blueyonder.co.uk
G Waddell
Cardiff University · GBEdinburgh Royal Infirmary · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDisc prolapse accounts for five percent of low-back disorders but is one of the most common reasons for surgery.

objectivesThe objective of this review was to assess the effects of surgical interventions for the treatment of lumbar disc prolapse. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Spine and abstracts of the main spine society meetings within the last five years. We also checked the reference lists of each retrieved articles and corresponded with experts. All data found up to 1 January 2007 are included. SELECTION CRITERIA: Randomized trials (RCT) and quasi-randomized trials (QRCT) of the surgical management of lumbar disc prolapse. DATA COLLECTION AND ANALYSIS: Two review authors assessed trial quality and extracted data from published papers. Additional information was sought from the authors if necessary. MAIN

resultsForty RCTs and two QRCTs were identified, including 17 new trials since the first edition of this review in 1999. Many of the early trials were of some form of chemonucleolysis, whereas the majority of the later studies either compared different techniques of discectomy or the use of some form of membrane to reduce epidural scarring. Despite the critical importance of knowing whether surgery is beneficial for disc prolapse, only four trials have directly compared discectomy with conservative management and these give suggestive rather than conclusive results. However, other trials show that discectomy produces better clinical outcomes than chemonucleolysis and that in turn is better than placebo. Microdiscectomy gives broadly comparable results to standard discectomy. Recent trials of an inter-position gel covering the dura (five trials) and of fat (four trials) show that they can reduce scar formation, though there is limited evidence about the effect on clinical outcomes. There is insufficient evidence on other percutaneous discectomy techniques to draw firm conclusions. Three small RCTs of laser discectomy do not provide conclusive evidence on its efficacy, There are no published RCTs of coblation therapy or trans-foraminal endoscopic discectomy. AUTHORS'

conclusionsSurgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. Microdiscectomy gives broadly comparable results to open discectomy. The evidence on other minimally invasive techniques remains unclear (with the exception of chemonucleolysis using chymopapain, which is no longer widely available).

Indexed as

DiskectomyLumbar VertebraeCicatrixHumansIntervertebral Disc ChemolysisIntervertebral Disc DisplacementRandomized Controlled Trials as Topic

Identifiers

PMID17443505
PMCPMC7028003
OpenAlexW1519449290

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.