NERVES Trial Summary

NERVES; NErve Root Block Versus Surgery
The NERVES trial is a randomised controlled trial  of the clinical and cost effectiveness of surgical microdiscectomy versus transforaminal epidural steroid injection (TFESI) to treat chronic radicular pain (sciatica) caused by a prolapsed intervertebral disc (or 'slipped disc').

Sciatica is a common condition reported to affect over 3% of the UK population at any given time. Over 90% of sciatica is attributable to a prolapsed intervertebral disc and those affected are commonly young, working adults. Although the duration and severity of pain can vary, if it lasts more than 6 weeks it is unlikely to get better imminently and may require investigation and treatment.

Treatment options currently include drugs, injections and surgical techniques to remove the prolapsed disc. There is currently no care pathway in the NHS that suggests any particular treatment and no direct comparison exists between surgical microdiscectomy and the transforaminal epidural steroid injection (TFESI). NERVES aims to address this by comparing surgical microdiscectomy to TFESI against various clinical and quality of life outcomes.

Eligible patients will have the following characteristics:

·        Diagnosed sciatica secondary to a prolapsed intervertebral disc

·    Symptom duration between 6 weeks and 12 months (6 - 52 weeks)

·    Age between 16 and 65 years

·    Patient will have attempted at least one form of conservative (non-operative) treatment but this has not provided adequate relief of pain/symptoms

·    Patient has provided written, informed consent

Patient will be ineligible if they have any of the following characteristics:

·       Neurological deficit (foot-drop / possible cauda-equina syndrome)

·    Previous spinal surgery at the same disc / level

·    Contraindication for surgery and / or injection

·    Patient known to be pregnant



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