This single-center RCT addresses a specific gap: what to do when sciatica from lumbar disk herniation has already failed to resolve after 4 months. 128 patients with L4-L5 or L5-S1 disk herniation and 4–12 months of symptoms were randomized to immediate microdiskectomy versus 6 months of standardized nonoperative care. The primary outcome was leg pain VAS at 6 months.
Prior trials established that acute sciatica (under 3 months) converges between surgery and conservative care by 6–12 months — but those trials did not enroll patients whose symptoms had already persisted beyond 4 months. This trial fills that gap directly.
When a patient presents with sciatica from an L4-L5 or L5-S1 disk herniation that has persisted for 4 months or more despite initial management, this trial supports offering microdiskectomy rather than another round of waiting. The leg pain benefit at 6 months exceeds the MCID and persists to 12 months across all measured domains.
A practical framing: one-third of patients who continue conservative care will end up needing surgery anyway, at a median of 11 months. Counseling patients on this crossover rate is part of the shared decision-making conversation.
The authors themselves caution that longer symptom duration has been correlated with worse outcomes after diskectomy in some prior studies. So the window for benefit is real, but it is not unlimited.
This single-center RCT addresses a specific gap: what to do when sciatica from lumbar disk herniation has already failed to resolve after 4 months. 128 patients with L4-L5 or L5-S1 disk herniation and 4–12 months of symptoms were randomized to immediate microdiskectomy versus 6 months of standardized nonoperative care. The primary outcome was leg pain VAS at 6 months.
Prior trials established that acute sciatica (under 3 months) converges between surgery and conservative care by 6–12 months — but those trials did not enroll patients whose symptoms had already persisted beyond 4 months. This trial fills that gap directly.
When a patient presents with sciatica from an L4-L5 or L5-S1 disk herniation that has persisted for 4 months or more despite initial management, this trial supports offering microdiskectomy rather than another round of waiting. The leg pain benefit at 6 months exceeds the MCID and persists to 12 months across all measured domains.
A practical framing: one-third of patients who continue conservative care will end up needing surgery anyway, at a median of 11 months. Counseling patients on this crossover rate is part of the shared decision-making conversation.
The authors themselves caution that longer symptom duration has been correlated with worse outcomes after diskectomy in some prior studies. So the window for benefit is real, but it is not unlimited.