Scaling Mount Sciatica: Will Surgery Help?
Sciatica is commonly thought of as pain along the sciatic nerve. When sciatica comes from a ruptured disc in the low back, it often causes pain to spread from the low back into the backs of the thighs. Most patients with sciatica start to feel better after a few weeks. But if the pain is ongoing or very intense, doctors may suggest surgery. Does surgery really help patients in the long run?

This study looked at the treatment results of 402 patients with sciatica. The patients were mostly men in their forties who had sciatica for less than six months. Two hundred twenty of them had surgery to remove the vertebral disc that was putting pressure on the nerve. The other 182 who didn't have surgery were treated with physical therapy, bed rest, steroids, and other nonsurgical treatments. Of the two groups, patients who chose surgery had more pain and worse functioning before treatment, though they rated themselves to be in better health overall. 

Doctors checked on the two groups for five years after treatment to see if the results changed. Patients who had surgery generally did better. Seventy percent of them had less low back or leg pain five years after treatment. Meanwhile, only 56 percent of patients who did not have surgery had less pain five years later. By comparison, patients who had surgery had better back functioning. These benefits leveled off after two years. However, surgery still showed better results at the five-year mark. 

Patients who had surgery were more satisfied with their treatment. Sixty-three percent of them were satisfied with their results versus 46 percent of those who didn't have surgery. Among patients who had surgery, 82 percent said if they had to go back, they would choose surgery again.

Work outcomes were about the same for both groups after five years. Both groups had the same percentage of patients on disability compensation. Patients who had surgery were a little more likely to be working, but this difference was so small that it wasn't felt to have much significance.

The benefits of surgery may depend on the patient's amount of pain. In this study, patients with less pain seemed to do well whether they had surgery or not. However, for patients with severe pain, surgery was a faster, better solution. The authors believe that patients with sciatic pain from a herniated lumbar disc who don't choose surgery will improve over time, but their recovery may be slower and less complete.
Steven J. Atlas, MD, MPH, et al. Surgical and Nonsurgical Management of Sciatica Secondary to a Lumbar Disc Herniation: Five-Year Outcomes From the Maine Lumbar Spine Study. In Spine. May 15, 2001. Vol. 26. No. 10. Pp. 1179-1187.