Long term Follow-Up of Surgical Microdiscectomy Versus Transforaminal Epidural Steroid Injection for Sciatica Secondary to Herniated Lumbar Disc: Results from the NERVES Trial

<title>Abstract</title> <p>Purpose The NERVES trial was a multicentre randomised controlled trial demonstrating comparable short-term outcomes following surgical microdiscectomy and transforaminal epidural steroid injection (TFESI) for sciatica secondary to lumbar disc herniation, supporting the use of TFESI as a first-line treatment option. Long-term outcomes and subsequent treatment pathways remain uncertain. This single-centre follow-up study evaluated long-term patient-reported outcomes and subsequent interventions according to original randomised allocation. Methods Eligible participants who had completed the 18-week follow-up in the parent trial were reassessed at a mean of 7.3 years after randomisation. Outcomes included subsequent interventions and patient-reported outcome measures (PROMs) including EQ-5D-5L, Core Outcome Measures Index [COMI], Modified Roland–Morris Disability Questionnaire, and numerical rating scale pain scores. Direct paired comparison with baseline or 18-week patient-reported outcomes was not feasible due to lack of participant-level data from the parent trial prevented by blinding and governance procedures. Results 27 of 76 eligible participants (35.5%) provided complete long-term follow-up data (13 surgery; 14 TFESI). No statistically significant differences in long-term patient-reported outcomes were detected according to the original randomised allocation of treatment despite numeric trends favouring surgery across several PROMs. In the participant group initially treated with TFESI 42.9% (n = 6) required no further invasive intervention, whereas 57.1% (n = 8) underwent additional treatment, most commonly surgery. In the surgical group 30.7% (n = 4) of participants required further intervention, all in the form of revision discectomy. Conclusions No statistically significant differences in long-term PROMs according to the original randomised treatment allocation were observed this result however shoult not be interpreted as equivelance. At time of follow-up, many participants had undergone subsequent interventions and therefore followed different treatment pathways. Although 42.9% of participants initially treated with TFESI required no further invasive treatment, the remainder (57.1%) underwent additional intervention, most commonly surgery. These findings suggest that long-term patient-reported outcomes are best interpreted in the context of treatment pathways over time rather than the isolated effects of the originally allocated interventions.</p>