Oral Presentation Sydney Spinal Symposium 2024

Smallest worthwhile effect of lumbar discectomy versus non-surgical options for sciatica: a benefit-harm trade-off study (108195)

Ali Salame 1 , Giovanni Ferreira 1 2 , Manuela Ferreira 1 , Christopher Maher 1 , Joshua Zadro 1 , Christine Lin 1 , Ashish Diwan 3 , Harrison Hansford 4 5 , James McAuely 4 , Mark Hancock 6 , Ian Harris 4 7 8
  1. The University of Sydney, Camperdown, New South Wales, Australia
  2. Institute for Musculoskeletal Health, Sydney, NSW, Australia
  3. St George & Sutherland Clinical School, St George Hospital, Sydney, NSW, Australia
  4. University of New South Wales, Sydney , NSW, Australia
  5. Centre for Pain IMPACT, NeuRA, Sydney, NSW, Australia
  6. Macquarie University , Sydney, NSW, Australia
  7. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
  8. The George Institute for Global Health, Sydney, NSW, Australia

 

 

Smallest worthwhile effect of lumbar discectomy versus non-surgical options for sciatica: a benefit-harm trade-off study

 

Aims

The primary aim of this study is to determine the smallest worthwhile effect (SWE) of discectomy in relation to non-surgical treatments amongst people with sciatica. The secondary is to explore clinical and demographic factors associated with the SWE of discectomy compared to non-surgical treatments.

 

Methods

This study uses a benefit-harm trade-off (BHTO) method to elicit the SWE of discectomy versus non-surgical treatments. Participants are recruited via social media and are eligible if they self-report a diagnosis of sciatica and lived in Australia. Participants are told that the study is investigating how effective surgery would have to be at reducing your leg pain to make you feel like having surgery is worthwhile given its inconveniences, costs, risks, and benefits. The primary outcome of the study is reduction in leg pain intensity. SWE was estimated as the median (IQR) of the lowest reduction in pain intensity (%) that participants considered worthwhile in addition to non-surgical treatment. Univariable quantile bootstrapped regression was used to explore the association of clinical and demographic factors with SWE – data are reported as difference in medians and bootstrapped 95% confidence intervals (CI).

 

Results

Recruitment is ongoing and 91 participants have been recruited so far. Mean (SD) age is 61.4 (9.1), most are females (57%), have an average leg pain intensity of 7.1 (1.9), 74% sought non-surgical treatment and 13% had previous surgery. The preliminary median (IQR) SWE is 10 (10-35). Males (-15, 95%CI -27 to -2.7,) those dissatisfied with previous non-surgical treatment (-10, 95%CI -19 to -0.3) but not duration of symptoms, leg pain intensity, depression and pain self-efficacy scores, were associated with lower SWE.

 

Conclusion

Preliminary data from our sample indicates a lower-than-anticipated overall median SWE and that some clinical and demographic factors may be associated with SWE of discectomy for sciatica.