Microdiscectomy versus autologous conditioned serum for degenerative lumbar disc disease with radiculopathy: a 12-month exploratory study

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• Picked for Spine Surgery (top studies of the week, 8 November 2026): Compares lumbar microdiscectomy with a nonoperative alternative

Abstract

INRODUCTION: Lumbar degenerative disc disease with radiculopathy that fails conservative care is usually treated surgically. Autologous conditioned serum (Orthokine®), an injectable anti-inflammatory blood-derived product, offers a less invasive alternative. Comparisons of these treatments rarely look beyond pain and disability, so quality of life, fatigue, and sexual functioning remain largely unexplored. We compared microdiscectomy and autologous conditioned serum across these domains and structural imaging outcomes over 12 months. METHODS: In this prospective, non-randomised cohort study, 140 patients with radiculopathy unresponsive to at least 6 months of conservative treatment underwent microdiscectomy (n = 86) or autologous conditioned serum injections (n = 54). Herniation morphology guided the clinical recommendation, and the final choice was made jointly by physician and patient. We assessed pain intensity, disability, pain quality, health-related quality of life, life satisfaction, fatigue, sexual satisfaction (Davies Sexual Satisfaction Scale), serum C-reactive protein, and magnetic resonance imaging parameters at baseline and at 3, 6, and 12 months. These outcomes were analysed with mixed-design (group × time) analysis of variance. RESULTS: Both treatments produced large improvements in every patient-reported domain, sustained to 12 months. Microdiscectomy provided faster relief. Significant group × time interactions for pain, disability, pain quality, physical and mental quality of life, and sexual satisfaction reflected advantages for microdiscectomy at 3 and partly 6 months, which were no longer significant at 12 months. The early differences in pain and disability persisted after adjustment for age, baseline scores, and herniation type. Life satisfaction and fatigue improved in parallel in both groups. Sexual satisfaction rose to near-maximal levels, and C-reactive protein declined similarly, in both groups. Spinal canal occupation remained lower after microdiscectomy, whereas disc height increased more after autologous conditioned serum from 6 months onward. DISCUSSION: At 12 months, the two treatments achieved comparable outcomes for pain, disability, quality of life, fatigue, and sexual satisfaction. Surgery offered quicker relief, whereas the injection-based approach was less invasive and was associated with greater disc-height gain. Measuring sexual satisfaction and fatigue alongside conventional endpoints broadens the evidence available for shared treatment decisions. These exploratory findings warrant confirmation in randomised trials.

Abstract as published, via PubMed.