Sometimes Surgery is Quickest Path to Sciatica Pain Relief

For severe sciatica pain, surgery is a valid option for pain relief, a new study shows. But researchers are also quick to point out that the study showed that typical sciatica will not worsen if surgery is delayed -- and that nonsurgical treatments can relieve at least some of the pain, especially leg pain.

The study, published in the May 31 New England Journal of Medicine, compared surgical treatment of back and leg pain (sciatica) caused by disc herniation.

Dante Implicito, MD, an orthopedic surgeon in Paramus, NJ, pointed out that non-surgical treatment or a wait-and-see approach isn't always right for the patient in term of quality of life. Some people are in so much pain, they can't function or may risk losing their jobs, so they opt for surgery (microdiscectomy) sooner. "(This study) shows that there can be tremendous improvement if patients are selected well for surgery," he said.

HealthDay reports: "The study...included 283 people who had severe sciatica -- leg pain caused by a compressed nerve in the spine (a herniated disc) -- for at least six to 12 weeks prior to the start of the study. Half of the group was selected to undergo early surgery -- an average of 2.2 weeks into the study; while the other half was chosen to receive conservative treatment with the option of surgery at a later date. Thirty-nine percent of the conservative treatment group eventually decided to have surgery, and the average time from the start of the study to the surgery was 18.7 weeks."

The findings:

1. Those who had a microdiscectomy sooner reported faster pain relief than the non-surgical treatment group.
2. Recovery for both the groups was same (95%) at the end of one year; however, the patients undergoing an early surgery experienced faster relief from sciatica.

Dr. Implicito emphasized that the most important thing someone with back pain can do is see a specialist with as much specific training in back problems as possible. "Back pain comes in a lot of different 'flavors', you need to be evaluated and diagnosed by a very well-trained person so you know what's relevant to your condition."

Posted by: Stephanie

Primary sources:

SOURCES: Weinstein, J.N. The New England Journal of Medicine, May 31, 2007; vol 356: pp 2257-2270. Peul, W.C. The New England Journal of Medicine, May 31, 2007; vol 356: pp 2245-2256. Deyo, R.A. The New England Journal of Medicine, May 31, 2007; vol 356: pp 2239-2243.

Additional reading:

• Sciatica
• Treatment Options for a Lumbar Herniated Disk