tailieunhanh - Ebook 50 landmark papers every spine surgeon should know: Part 2

(BQ) Part 2 book “50 landmark papers every spine surgeon should know” has contents: Surgical versus nonsurgical treatment for lumbar - degenerative spondylolisthesis, ervical spine fusion in rheumatoid arthritis, classification of spondylolysis and spondylolisthesis, the impact of positive sagittal balance in adult spinal deformity, and other contents. | Sec t ion T hre e • D e ge nerat ive Chapter 21 Lumbar Disc Herniation: A Controlled, Prospective Study with 10 Years of Observation Weber H, et al. Spine 1983 Reviewed by Raj Gala and Peter G. Whang Research 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 diagnostic imaging in the conservatively treated groups. Prior to this study, there was a paucity of randomized controlled trials comparing operative to nonoperative management. Throughout previous nonrandomized comparative studies, the reported outcomes were inconsistent, and there was additional uncertainty surrounding the longevity of treatment effects observed with operative versus nonoperative treatment. The current study aimed to produce more reliable 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 associated lumbar disc herniation for whom the authors believed there was true equipoise between the two treatments. The study also included two prospective nonrandomized observational arms: a group of patients who were thought to have definitive indications for surgery (Group 2) and a group of patients who were selected for conservative management (Group 3) because they demonstrated continued improvement with initial nonoperative treatment. Sample Size The 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 patients who were felt to have