NErve Root Block VErsus Surgery (NERVES)
A multi-centre randomised control trial comparing the clinical and cost effectiveness of trans-foraminal epidural steroid injection to surgical microdiscectomy for the treatment of chronic radicular pain secondary to prolapsed intervertebral disc herniation
NIHR HTA Programme
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.
The trial is sponsored by The Walton Centre NHS Foundation Trust and the day to day running of the trial is being coordinated by the team at the Liverpool Clinical Trials Centre.