May 30, 2007 (Insidermedicine) A comparison of the one-year outcomes of surgery and a longer-than-usual conservative approach has shown that both options produce comparable pain relief. While the rates of pain relief and perceived recovery were faster for those who received early surgery, the results of the study published in the latest issue of the New England Journal of Medicine indicate the less invasive and less costly conservative approach may be a better option for those suffering from sciatica. 

The leg pain that is characteristic of sciatica – most often the result of a spinal disc injury –  is a common misery, afflicting over two million adults in Canada and the United States. Sciatica also exacts huge economic costs in treatment and disability. Currently, patients often receive lumbar back surgery if the pain has not subsided within 6 weeks. However, the wisdom of this timing is unclear, as there is no consensus as to how long conservative treatment should be offered before the more invasive surgical option is pursued. 

Researchers from The Netherlands randomly divided 283 patients into two groups, which received either surgery within several weeks or conservative treatment, which typically lasted almost 19 weeks, about three times longer than is typically done. Outcomes were assessed by the use of the Roland Disability Questionnaire and statistical evaluations of the outcomes, and by the subjective perceptions of the patients.  

Of those who were treated conservatively, almost 40% went on to have surgery, while about 60% did not require surgery. While the relief of leg pain and recovery was faster in the original surgery group, recovery was the same in both groups after one year, and there was no difference in disability between the two groups.  

Thus, the researchers conclude that while the main benefit of surgery lies in its faster pain relief, the longer conservative treatment route is no less effective. In consultation with their physician, "patients whose pain is controlled in a manner that is acceptable to them may decide to postpone surgery in the hope that it will not be needed, without reducing their chances for complete recovery at 12 months," conclude the researchers. 

Reporting for Insidermedicine, I’m Dr. Petra Joller.