Microdiskectomy Bests Nonsurgical Care for Sciatica Pain

Lumbar surgery is superior to conservative treatment for chronic sciatica caused by disc herniation, according to a new study.

Researchers at London Health Sciences Centre (Canada), St. Joseph’s Hospital (SJHC; London, Canada), the University of Western Ontario (UWO, London, Canada), and other institutions conducted a study involving 128 patients with long-term sciatica and lumbar disk herniation. The patients were randomized to microdiskectomy or to six months of standardized non-operative care, followed by surgery if needed. The primary outcome was intensity of leg pain on a visual analogue scale (VAS) at six months after enrollment; secondary outcomes were Oswestry Disability Index, back and leg pain, and quality-of-life scores.

The results revealed that at baseline, the mean score for leg-pain intensity was 7.7 in the surgical group and 8.0 in the nonsurgical group. The primary outcome of leg-pain intensity score at six months was 2.8 in the surgical group and 5.2 in the nonsurgical group. Of the 64 patients in the nonsurgical group, 34% crossed over to undergo surgery. Nine patients had adverse events associated with surgery, and one patient underwent repeat surgery for recurrent disk herniation. The secondary outcomes followed the primary outcome. The study was published on March 18, 2020, in the New England Journal of Medicine (NEJM).

“My take-home message is that, unlike acute sciatica, chronic sciatica is much less responsive to non-operative treatment, and with surgery it is 70% more likely to significantly improve,” said lead author Chris Bailey, MD, of the Western University Bone and Joint Institute. “Whether to prescribe surgery or conservative treatment in these persistent sciatica patients is controversial, because a longer duration of symptoms has been correlated with a poorer outcome associated with lumbar discectomy in some studies.”

Lumbar disk herniation is a common, often debilitating, condition that occurs when the nucleus pulposus bulges through a tear in the disk's exterior layer and puts pressure on the nerve root ganglion. Herniated disks are often the source of sciatica, a pain that radiates downward from the lower back into the leg. Conservative treatment options range from pain medications to corticosteroids injected directly into the affected area of the spine. Those who don't respond may require surgery.

Related Links:
London Health Sciences Centre
St. Joseph’s Hospital
University of Western Ontario