Surgery or Conservative Care for Sciatic Pain?

When a patient discovers they have sciatica due to lumbar disc herniation, one of the first questions they have to answer is whether or not they wish to undergo surgery. Numerous studies have explored that question, and a 2010 review of the literature on sciatica treatment brings us closer to an answer.

The study revealed there is inconsistent evidence on whether surgery is more beneficial than conservative care. In the review, researchers evaluated several studies comparing surgery to prolonged conservative treatment for sciatica due to lumbar disc herniation. They discovered that many of the leading studies were subject to bias towards surgery--a bias which may have tainted the results.

Only two of the leading studies were considered to have low bias. One found that surgery provided faster relief of leg pain, but that differences between surgery and conservative care diminished after 1-2 years. At the annual follow-ups, both groups of patients had substantially improved. Another study confirmed that there were no major differences between conservative care and surgery in the long-term.

Despite that one study suggested that surgery may provide faster relief, the initial benefit may be out weighed by the costs and risks of surgery, researchers said.

They concluded that more research is needed to understand which patients may benefit more from surgery and which will benefit more from conservative care. Since both may be equally effective in the long term, for now, it's up to patients to decide whether surgery is worth the additional cost and risk.

Jacobs, WC, M. van Tulder, M Arts, SM Rubinstein, et al. Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review." European Spine Journal 2011;20(4): 513-22.