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Award-Winning Study Shows Endoscopic Treatment Works, Cost-Effectively, for Sciatica

Weill Cornell Medicine Brain and Spine Center research fellow Pravesh Gadjradj, MD, PhD, MSc, recently published two papers showing that endoscopic treatment for sciatica caused by disc herniation is just as effective as open microdiscectomy, at a lower total cost. The papers, which Dr. Gadjradj co-authored with his colleagues in the Netherlands, report on the results of a clinical trial of more than 600 patients with sciatica treated at four different hospitals in that country over the course of a year. Half of them had percutaneous transforaminal endoscopic discectomy (PTED) and the other half underwent open microdiscectomy.

The research was given a Charlie Kuntz Scholar Award and the Sanford Larson Award for Best Research at the annual meeting of the AANS in 2022.

In the first paper, Full Endoscopic Versus Open Discectomy for Sciatica: Randomised Controlled Non-Inferiority Trial, published in the British Medical Journal, Dr. Gadjradj and team reported on results after surgery as well as one year later. Patients who underwent endoscopic surgery had less blood loss, shorter hospital stays, and were on their feet sooner than those who had open surgery. At 12 months, the endoscopic patients had less leg pain than the open microdiscectomy group. Re-operation rates were similar. Researchers concluded that endoscopic surgery is as effective as microdiscectomy at relieving symptoms of sciatica, with all the benefits of a less invasive surgery.

Dr. Gadjradj talks about the results on video here

The second paper, Cost-Effectiveness of Full Endoscopic Versus Open Discectomy for Sciatica, published in the British Journal of Sports Medicine, compared the costs of the endoscopic surgery to that of open microdiscectomy. Although the surgery cost itself was higher for endoscopy (due to the cost of endoscopes), the overall costs were lower, primarily due to the shorter hospital stay and faster resumption of work, making the endoscopic surgery the overall more cost-effective approach. The study also reported on other associated costs, including societal costs of work absenteeism and the reduced productivity of workers in pain, and found favorable results for endoscopic surgery.

Dr. Gadjradi earned his MD, PhD and MSc degrees at Erasmus University in Rotterdam in 2018. He is currently working with Dr. Roger Härtl as a post-doctoral fellow in spine surgery.

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