Sciatica, Is Surgery the Best Option?

By: Dr. Eric Read

A major study published in the Journal of the American Medical Association, found that for back pain with radiating pain from lumbar disc herniation, patients recover almost equally well with or without surgery. In many cases it used to be thought that surgery was needed for this sort of condition and that waiting for surgery could be harmful. But this study has shown that waiting is almost as beneficial as surgery, and more importantly there is no risk or significant harm in waiting.

Sciatica is the name given for low back pain that radiates down your leg. In your spine there are a group of nerves that branch off the spinal cord near the lumbar spine and join together further down to make one large nerve called the sciatic nerve that then runs down through your buttocks and continues down into your legs and feet. Compression to this nerve near the lumbar spine can cause radiating pain down into your legs or feet.

Most often a herniated, or bulging disc from between the vertebra of you lumbar spine, puts pressure on the sciatic nerve. There are also other causes like degenerative changes to your spine or muscle spasms close to the sciatic nerve. Previously it was believed that surgery was required to remove the portion of the bulging disc away from the nerve and relieve the pressure on the sciatic nerve and relieve the patients pain. But it has been shown time and time again, that surgery is only effective in some people, and usually the results aren’t lasting, and many people have the same or worse pain within just a few years. As pointed out previously, a bulging disc isn’t always the cause of sciatica, so why remove parts of discs that aren’t causing a problem? Also many MRI’s show bulging discs in patients that aren’t having any problems at all, so discs aren’t always the problem.

This study looked at 501 surgical candidates that had a disc herniation and persistent radiating pain for six weeks or more. They were divided into two groups. The surgery group received a discectomy with removal of disc fragments from around the nerve root. The second group got individualized care ranging from physical therapy, home exercises, pain medications, and chiropractic care.

Outcomes were measured by taking baseline measurements at the beginning, then at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Both groups showed strong improvements at each follow up period. Complications from the initial surgery occurred in 5% of the surgery candidates with 4% needing a second surgery within the first year.

This study did not compare surgery to chiropractic care. A few years ago there was a large study that did show chiropractic care was effective for sciatica cases where regular medical care like physical therapy and drugs had not helped. Over 3,000 people were studied with low back and sciatic pain who had no positive results with standard medical care. They were then put under chiropractic care and over half of those 3,000 patients had excellent results with no relapses and another 34% improved but had relapses. Only 15% had no significant improvement.

I think the most important finding of this study, shows that conservative care like chiropractic tried first, is often times effective and above all, there is no harm in waiting to see if something else will work. Surgery on the spine is inherently dangerous. There is also a lengthy recovery process and substantial costs involved in any surgery. Chiropractic care is relatively inexpensive compared to surgery, has a fraction of the risk, and there is no harm in waiting on surgery, so trying chiropractic care first seems like a logical choice for those suffering from sciatica.