Is surgery for sciatica resulting from herniated discs worth it?

The answer seems to be a cautious “yes,” with experts noting that, for many patients, non-surgical methods may work just as well.

Comparing Surgical and Non-Surgical Approaches

Two related studies, using different methodologies, found that back surgery did produce slightly better outcomes than non-surgical treatment. Both studies are published  Nov. 22/29 issue of the Journal.” bottom line surgery works,” said Dr. Todd Albert, co-author and vice chairman orthopedics president in Philadelphia. “Non-operative treatment can work, and people can do well with it, but surgery worked better.”

Selective Use of Surgery

But surgery is not for everyone, added another of the study’s authors, Dr. Alan S. Hilibrand, associate professor of orthopedic surgery at Jefferson Medical College.

“The person who comes in with leg pain from a herniated disc has a good chance of getting better with non-operative treatment and, unless they have certain unusual things going on, they should be treated non-operationally initially,” he said. “If they’re not getting better, they’re likely to do well with surgery.”
In fact, in general, the procedure should be reserved for herniated discs causing leg pain (sciatica), not for back pain caused by degenerated discs, Hilibrand explained.

Understanding Herniated Discs

Herniated discs occur when the nucleus of a spinal disc — the cushioned part of the spine — pushes into the spinal canal due to a tear or rupture. Many people recover from herniated discs on others require operations.

That whether and when appropriate in the first study, close to 500  undergo surgery or receive non-operative treatment, which counseling.

Those undergoing surgery had slightly better areas one caveat:  high crossover, meaning many patients switched groups. This made direct comparisons more difficult, the authors said.

The companion article was an observational study, which simply followed 743 patients with persistent sciatica who had chosen surgery or usual (non-surgical) care. All patients reported improvements over two years, although those who chose surgery experienced greater improvements.

Clinical Practice Implications

How will the findings affect practice? Perhaps, not at all, experts said. “I don’t think it will necessarily change practice, but it will help surgeons to counsel patients,” Albert said. “We could say to patients ‘Look, we know you’ll do great with surgery if you want to go forward, but if you’re too scared, we might get you to do pretty well with other methods.’ ” And it may help iron out the regional differences.

“There are a lot of people out there saying no one should have surgery, and they’re probably not right about that,” said Hilibrand, who is also director of medical education in the Department of orthopedic surgery at Thomas Jefferson University Hospital.

“Some are saying you should have surgery right away, and that’s probably not right, either. Hopefully, this will lead to more standardization of care.”