Commentary
An important concern for patients with radiculopathy associated with intervertebral disc herniation involves the better short-term and long-term outcomes associated with surgical discectomy versus medical therapy. Patients need to balance the possibility of rapid resolution of back and leg pain against the potential risks of advanced spinal degeneration caused by surgical intervention. Prior studies have reported a benefit for surgical patients early in the post-operative period. In a prospective study of 126 patients randomized to surgical discectomy versus conservative therapy, the difference in early surgical benefits tends to equalize over a 10-year follow-up period as reported by Weber.1 However, the effects of surgery on clinical symptoms and advancement of spinal degeneration over a longer period than a decade were unknown.
I was reassured by the overall results of this long-term, 25-year follow-up study reported by Mariconda and colleagues demonstrating the satisfaction of surgical patients with their operations as documented by validated outcome measures. A majority of patients undergoing surgery can be pain-free and functional without progressive spinal disorders. I was concerned, however, about several aspects of the study. For example, a significant number of individuals from the initial cohort have been lost to follow-up. Also, a small but significant proportion of study enrollees required additional spinal surgeries and were disabled.