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Lumbar disc herniation: a controlled, prospective study with 10 years of observation

PainSci » bibliography » Weber 1983
Tags: etiology, diagnosis, biomechanics, back pain, surgery, classics, sciatica, spine, leg, treatment, pro, pain problems, butt, hip, limbs

One article on PainSci cites Weber 1983: The Complete Guide to Low Back Pain

PainSci commentary on Weber 1983: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This paper is old enough and good enough to be considered a bit of a classic. In addition to a good sample size and very long follow-up, it was noteworthy in at least two even more significant ways:

  1. An extremely rare example of a direct comparison of a common surgery to conservative care. Although not placebo controlled (there was no sham surgery involved), the spirit of a head-to-head test was quite unusual, and it remains scarce well into the 21st Century. The results favoured surgery slightly at one year, and barely at four.

  2. And was also one of the earliest papers to clearly show that there's only a sloppy correlation at best between symptoms and the status of disc herniation — much like later studies (see Fraser, Barth 2008, Barzouhi 2013).

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Two hundred eighty patients with herniated lumbar discs, verified by radiculography, were divided into three groups. One group, which mainly will be dealt with in this paper, consisted of 126 patients with uncertain indication for surgical treatment, who had their therapy decided by randomization which permitted comparison between the results of surgical and conservative treatment. Another group comprising 67 patients had symptoms and signs that beyond doubt, required surgical therapy. The third group of 87 patients was treated conservatively because there was no indication for operative intervention. Follow-up examinations in the first group were performed after one, four, and ten years. The controlled trial showed a statistically significant better result in the surgically treated group at the one-year follow-up examination. After four years the operated patients still showed better results, but the difference was no longer statistically significant. Only minor changes took place during the last six years of observation.

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