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In a recent randomized trial, 128 patients with sciatica, herniated disc with nerve-root compression at the L4–L5 or L5–S1 level, and unilateral leg pain for 4 to 12 months were randomized to microdiskectomy or conservative management (NEJM JW Gen Med Apr 15 2020 and N Engl J Med 2020; 382:1093). Although both groups improved with time, those in the diskectomy group had significantly less leg pain than those in the conservative-management group at 1 year (average difference, 2.1 points on a 0–10-point scale). Now, the researchers provide additional follow-up.
In intent-to-treat analysis at 2 years, the mean difference in leg-pain score (the primary outcome) had narrowed to 1.3 points — a statistically significant, but clinically marginal, di…