In Reply: Dr Rahimi-Movaghar and colleagues raise 2 possible confounding factors that might be responsible for differences in outcome. The first was the learning curve of tubular diskectomy. They suggest that the duration of surgical time of any new technique will decrease over the course of the learning curve, and assessment of the efficacy of the new procedure against a reference standard may be affected by when the comparison occurred on the learning curve. We agree, and therefore inexperienced surgeons did not participate in this trial. All participating surgeons had experience in tubular diskectomy and the suggested asymptote of approximately 30 cases was reached before participating in the trial.1 In our study, the majority of patients (233 [69%]) were operated on by surgeons who had experience for more than 5 years with at least 50 surgeries per year.
Arts MP, Peul WC. Comparing Surgical Treatments for Sciatica—Reply. JAMA. 2009;302(20):2202-2203. doi:10.1001/jama.2009.1723