Background Percutaneous
laser disc
decompression is a minimally invasive treatment, for lumbar
disc herniation and might serve as an alternative to surgical management of
sciatica. In a randomised trial with two-year follow-up we assessed the clinical effectiveness of percutaneous
laser disc
decompression compared to conventional surgery. Materials and methods This multicentre randomised prospective trial with a non-inferiority design, was carried out according to an intent-to-treat protocol with full institutional review board approval. One hundred and fifteen eligible surgical candidates, with
sciatica from a
disc herniation smaller than one-third of the spinal canal, were randomly allocated to percutaneous
laser disc
decompression ( n = 55) or conventional surgery ( n = 57). The main outcome measures for this trial were the Roland-Morris Disability Questionnaire for
sciatica, visual analogue scores for back and leg
pain and the patient's report of perceived recovery. Results The primary outcome measures showed no significant difference or clinically relevant difference between the two groups at two-year follow-up. The re-operation rate was 21% in the surgery group, which is relatively high, and with an even higher 52% in the percutaneous
laser disc
decompression group. Conclusion At two-year follow-up, a strategy of percutaneous
laser disc
decompression, followed by surgery if needed, resulted in non-inferior outcomes compared to a strategy of microdiscectomy. Although the rate of reoperation in the percutaneous
laser disc
decompression group was higher than expected, surgery could be avoided in 48% of those patients that were originally candidates for surgery. Percutaneous
laser disc
decompression, as a non-surgical method, could have a place in the treatment arsenal of
sciatica caused by contained
herniated discs.