Peul sciatica trial (Sciatica Trial)

Surgery versus prolonged conservative treatment for sciatica

Peul WC, van Houwelingen HC, van den Hout WB, et al. The New England journal of medicine 2007 · PMID 17538084 · doi:10.1056/nejmoa064039

Question

In sciatica from lumbar disc herniation lasting 6-12 weeks, does early microdiscectomy give better outcomes than prolonged conservative care with surgery only if needed?

Design

Multicentre RCT in Dutch hospitals.

Patients

Adults with severe radicular leg pain of 6-12 weeks' duration and an MRI-confirmed disc herniation matching the symptoms.

Intervention

Early microdiscectomy

Comparison

Prolonged conservative treatment, with surgery offered if symptoms persisted or worsened

Primary outcome

Roland Disability Questionnaire, leg pain VAS and global perceived recovery over 1 year

Key result

Early surgery produced faster relief of leg pain and faster perceived recovery, but by 1 year outcomes were similar between groups; a substantial proportion of the conservative group eventually had surgery.

Limitations

Crossover to surgery in the conservative arm and lack of blinding complicate interpretation; patients with cauda equina or severe motor deficit were excluded.

Impact on practice

Supports shared decision-making: surgery buys quicker recovery rather than a better long-term result, so either early surgery or a further period of conservative care is reasonable.