Deciding to undergo surgery is never an easy decision. Here we profile a landmark clinical study to help you in making your decision.
This study, Surgery versus Prolonged Conservative Treatment for Sciatica, published in the New England Journal of Medicine, was conducted to help address the question of whether anyone with severe sciatica symptoms from a herniated disc should have surgery sooner or try to prolong nonsurgical (termed conservative) treatment.1 While this study is not brand new, the findings remain relevant today.
The natural course of sciatica—also called a lumbar radiculopathy—is to resolve over time, usually over a few weeks or months. However, for some people with a lumbar herniated disc, the pain that travels down the nerve and into the leg can be severe, almost unbearable. And it can limit your ability to function at work, parenting, and other activities of daily life. For these people, the study sought to provide information regarding the question of if and when surgery should be considered.
Surgery versus prolonged nonsurgical treatment for sciatica
The primary finding in this study is that for severe sciatica pain caused by a lumbar disc herniation, having surgery sooner is a valid option for pain relief.
The study compared surgical treatment of back and leg pain (sciatica) caused by disc herniation to non-surgical treatment. It included 283 people suffering with severe sciatica stemming from a disc herniation for at at least 6 to 12 weeks. It was conducted as a multi-center, randomized study, and included 9 hospitals.
Results of the study showed:
- 141 patients were randomly assigned to have microdiscectomy surgery within roughly two weeks after randomization. Of those, 16 recovered before having the surgery, so 125 had the microdiscectomy.
- 142 patients were assigned conservative—or nonsurgical—treatment with the option of surgery at a later date
- Of those assigned to nonsurgical treatment, 39 percent did not get sufficient pain relief and eventually decided to have surgery. On average, they decided to have surgery 18.7 weeks after the start of the study, or about 16 weeks later than those assigned to have surgery near the start of the study.
- Those who had a microdiscectomy sooner reported faster pain relief than the non-surgical treatment group
- Recovery for both groups was same. At a one-year followup, both groups had a 95 percent rate of perceived recovery. However, the patients undergoing an early surgery experienced sciatica pain relief sooner—about 16 weeks sooner for the ones who started out in the nonsurgical group but then opted for surgery at a later date.
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One consideration worth noting is that a microdiscectomy surgery has relatively high success rates in relieving sciatica pain, and compared to many other surgeries it is a relatively minimally invasive surgery. It does not permanently change the structure of the spine, as a microdiscectomy only removes the portion of the disc that has extruded—or herniated—out of the disc.
See Sciatica Surgery
In addition to a microdiscectomy, a percutaneous or endoscopic approach to the surgery is also now available.
The decision of when and if you want to have surgery for sciatica is a personal one. Only you know how much the pain and other symptoms are affecting your daily life, and only you know your preferences for treatment.
Reading and understanding as much as you can about the types of surgery available for a lumbar herniated disc, the types of nonsurgical care available, and carefully researching a surgeon or other health care professional, will all go a long way in helping you make a well-informed decision that is best suited for you and your personal situation.
- Peul, W.C., The New England Journal of Medicine, May 31, 2007; vol 356: pp 2245-2256.