New research suggests that surgery for sciatic nerve pain may not lead to better outcomes when compared to conservative care. However, the patients that had surgery had faster relief from pain which has important implications if you are a breadwinner and you need to get back to work.
The authors wanted to find out if having lumbar disc surgery is better than simple non surgical conservative care for people with sciatic nerve pain from a disc bulge. This surgery is called 'microdiscectomy' and is commonplace in western society.
The study looked at 283 patients with between 6-12 weeks of sciatica and randomly put 50% of them in for surgery, the other 50% were taken care of by their doctors. This care included reassurance that the symptoms would eventually settle, lower back pain relief medication and advice to remain active. If the patient had a lot of fear avoidance then a physiotherapist offered guidance and help too.
Its worth noting that 62 of the patients who were having the non-surgical treatment ended up having surgery in the end because of pain or worsening neurological signs.
Also of interest is the fact that in 6% of surgically treated patients the sciatic nerve pain came back which meant they had to have more surgery.
There was a big difference in pain scores between the groups in the first 6 months – the surgically treated patients felt better. However, these differences disappeared after that and both groups ended up the same.
In fact by the end of the first year 95% of patients in both groups had a satisfactory recovery, and this was the same after two years.
There are of course other things to think about.
Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial -- Peul et al., 10.1136/bmj.a143 -- BMJ. Available at: http://www.bmj.com/cgi/reprint/bmj.a143v1 [Accessed June 6, 2008].