Early Surgery Relieves Sciatica Pain Faster, but Nonsurgical Treatment Is Just as Effective in the Long-term
]]>Sciatica]]> is a radiating, often disabling discomfort in the leg due to pressure on the sciatic nerve as it leaves the spinal column in the back. Although the majority of sciatica cases improve on their own, under certain circumstance sciatica can also be treated with surgery. However, doctors do not know whether it is better to do the surgery early or to wait and see whether other treatment options work first.
In a study published in the May 31, 2007 New England Journal of Medicine , researchers compared the effects of early surgery to an extended period of physical therapy plus medication in people with severe sciatica. They found that patients who had early surgery experienced significantly faster pain relief. However, after one year, patients in both treatment groups reported similar levels of pain relief, disability, and recovery.
About the Study
The researchers recruited 283 patients, aged 18-65, who had severe sciatica for 6-12 weeks. Half of the patients were scheduled to undergo surgery within two weeks. The other half received nonsurgical treatment aimed at allowing them to resume daily activities, including pain medication as necessary. The nonsurgical patients had the option to undergo surgery if their leg pain continued or increased. All of the study participants scored their levels of disability, intensity of leg pain, and perceived recovery at several points throughout the one-year study period.
Eighty-nine percent of patients assigned to early surgery had surgery within 2.2 weeks of the start of the study. Of the patients assigned to nonsurgical treatment, 39% chose to undergo surgery after an average of 18.7 weeks. The early surgery patients had significantly faster relief from leg pain than the nonsurgical patients. However, there was no significant difference in disability scores between the two groups during the study. By the end of the study, 95% of patients in both groups considered themselves to have recovered.
This study is limited by the fact that more than one-third of the patients assigned to nonsurgical treatment chose to undergo surgery during the course of the study.
How Does This Affect You?
This study found that early surgery leads to faster relief of leg pain from sciatica. However, patients who do and do not undergo surgery have similar levels of leg pain, disability, and recovery after one year.
When you are choosing a treatment option, ask your doctor to help you evaluate the pros and cons of surgery. Sciatica occurs for a variety of reasons, and the success of surgery will depend on its cause in your particular case. Bear in mind, though, that 75% of sciatica cases in general improve within three months, even without surgery, and that surgery always comes with its own risks. On the other hand, you may find the pain from sciatica to be intolerable and may not be willing or able to allow your sciatica to resolve more slowly on its own. Despite the encouraging results of this study, how best to proceed is still a highly individual decision.
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health
National Pain Foundation
Deyo RA. Back surgery—who needs it? [Perspective.] N Engl J Med . 2007; 356:2239-2243.
Peul WC et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med . 2007; 356: 2245-2256.
Last reviewed July 2007 by ]]>Dr. Richard Glickman-Simon, MD]]>
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