Benefits of Disc Surgery for Sciatica Questioned
Spinal disc surgery is one of the most commonly prescribed procedures for sciatica, but a new study suggests that treatment may not be the best option for many patients with back pain and sciatica. The study suggests that for a significant number of sciatica patients with lower back pain, herniated discs are not to blame for their symptoms, and therefore treatments aimed at spinal discs will do little to provide relief.
Sciatica is a debilitating condition caused by impingement or irritation of the sciatic nerve, leading to tingling sensations, numbness, and pain in the legs. These symptoms are frequently accompanied by lower back pain.
Researchers publishing in the journal PLoS One, tracked the progress of 379 patients with severe sciatica over the course of a year-long treatment. Overall, 221 suffered from sciatica without back pain, and 158 had sciatica with disability back pain. MRI scans revealed that only 68% of patients with sciatica and back pain showed signs of nerve root compression, compared to 88% of sciatica patients without back pain. Additionally, patients with sciatica had a higher likelihood of disc herniation than those with additional back pain (91% versus 76%).
The patients were randomly assigned to receive either lumbar disc surgery or conservative care managed by a general practitioner and/or a physiotherapist. At the one year follow up, the researchers discovered that sciatica patients without back pain had a better chance of recovery, regardless of treatment type. More surprisingly, patients who did have a herniated disc at the start of the study were actually more likely to recover. In contrast, the presence of lower back pain and/or the absence of a herniated disc was associated with more pain and disability after one year.
With the large percentage of patients suffering from sciatica in the absence of disc herniation or nerve compression, the researchers wrote, "The worldwide accepted mechanical compression theory therefore seems not to offer a sufficient explanation for the cause of the disabling back and leg symptoms in sciatica." They pointed out that nerve root inflammation may be an additional cause of sciatica.
Research suggests that 15-40% of sciatica patients do find satisfactory relief one year after surgery. In fact, many of these patients develop recurring disc herniation, in what has been dubbed "failed back surgery syndrome."
In order to successfully address sciatica, the study authors argued that patients be categorized into specific subgroups. "A shift from a 'one-size fits all' approach, where heterogeneous groups of patients receive broadly similar treatments, towards targeted treatments according to prognostic profiles or specific characteristics, may help to improve the treatment results," the researchers wrote.
Chiropractors call on a broad base of non-invasive, drug-free treatment options when working with sciatica patients. Depending on your specific symptoms, your individualized treatment could include chiropractic adjustments, exercises, massage, physical therapy, spinal decompression, and more, depending on your chiropractor. If you suffer from both back pain and sciatica, chiropractic can help. Studies show that patients who receive chiropractic care and exercise therapies frequently find relief.
el Barzouhi, et al. Influence of low back pain and prognostic value of mri in sciatica patients to back pain. PLoS One 2014 ; 9(3): e90800.