Bottom line
- Surgery improves pain and function faster than non-surgery
- However due to cross over the randomized group's surgical benefit is lost
- Looking at the observational group surgical benefits tend to stay significant even at the 8 year mark
Cons:
- Adherence to assigned treatment was limited:
- 50% of patients assigned to surgery received surgery within 3 months of enrolment,
- 30% of those assigned to nonoperative treatment received surgery in the same period.
- The strict eligibility criteria, however, may limit the generalizability of these results.
- Patients unable to tolerate symptoms for 6 weeks and demanding earlier surgical intervention were not included, nor were patients without clear signs and symptoms of radiculopathy with confirmatory imaging.
Note:
- They kept the intent to treat which comprised of pt who was randomized to surgery then had surgery and also pt who were randomized to have surgery but did not have surgery so that to reduce the baseline confounding factors between the two groups
- The authors have tried to keep the baseline characteristic of both groups for the as treated observational group the same
- Oster 2020: 10 year outcome
- In observational group greater improvement in primary outcomes (SF-36 and ODI) from 3 months to 8 years in patients who had surgery
- In RCT: no statistical significant difference
- Early surgery associated with better short term outcomes but had similar long term outcome
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