Preventing lumbar disc surgery

Lumbosacral radicular syndrome is commonly caused by a herniated nucleus pulposus. In
the past decade, in the Netherlands, the incidence rate of sciatica has increased from 75 000
to 85000 per year, resulting in around 1.2 billion euros in direct and indirect costs per
year. The majority of sciatica patients end up receiving surgery even though conservative
treatment was previously found to be equally successful at long term follow-up. Moreover,
surgery is associated with high costs and complications. Conservative methods
for sciatica include transforaminal epidural steroid injections and physiotherapy/mechanical
diagnosis therapy, both of which have been reported to be individually successful treatments.
However, as far as we are concerned, our pilot study was the only study that has assessed the
effects of a combination therapy, consisting of mechanical diagnosis therapy and
transforaminal epidural injections, in reducing surgery rates. Hence, this study aims to
determine if such a combination therapy, while being on the waiting list for a lumbar herniated
disc surgery, is effective and cost-effective compared to usual care (i.e. no intervention
while being on the waiting list) in reducing surgery rates among HNP patients with an indication
for a lumbar herniated disc surgery.

A combination therapy (MDT and TESIs) is effective and cost-effective compared to usual care among herniated nucleus pulpos patients with an indication for a lumbar herniated disc surgery

Timepoint: baseline, 4 weeks, 2 months, 4 months, 6 months, 9 months, 12 months.

Intervention condition: Mechanical Diagnosis and Treatment (McKenzie treatment) (with Transforaminal Epidural Steroid Injection(s)) while being at the waiting list to receive lumbar disc surgery.

Control condition: Being at the waiting list to receive lumbar disc surgery.