Sciatica can be treated by surgery or waiting

AORN Journal,  Jan, 2007  

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A new study reveals that patients with sciatica can choose either surgical intervention or simply waiting to see if symptoms resolve without experiencing serious consequences, according to a Nov 22, 2006, article in The New York Times. Although surgical intervention appears to relieve a patient's pain more quickly, the study found that people who waited for three to six months while undergoing physical therapy and counseling and taking anti-inflammatory medications eventually recovered from sciatica.

Sciatica tends to run in families and occurs when the soft, gel-like material inside a spinal disk ruptures and protrudes through the outer lining of the disk. This protrusion compresses and inflames the root of the sciatic nerve, which runs down the back of the leg. Patients with this condition report pain that manifests

* Like a burning fork in the buttocks,

* as weakness in a leg, or

* as a searing pain down the back of the leg.

Some patients who suffer from sciatica are unable to walk, some cannot sit, and some can barely crawl. As many as one million Americans suffer from sciatica, and it is estimated that 300,000 patients undergo a surgical procedure to relieve symptoms of sciatica each year.

Researchers conducted a two-year study comparing surgery with waiting in nearly 2,000 patients with sciatica in 13 spine clinics in 11 states. These patients were asked whether they would allow the researchers to randomly assign which treatment they would receive. Those who did not undergo surgical intervention received physical therapy, counseling, and anti-inflammatory medications. Approximately 40% of the patients assigned to have a surgical procedure elected not to have it because their conditions improved while they were awaiting surgery. One-third of the patients who were assigned to the waiting group elected to proceed with a surgical procedure because of the intensity of their pain. Researchers also obtained data from patients who were unwilling to be assigned at random to track the treatment they chose and how they fared.

After two years, approximately 70% of patients in both groups indicated that they had a major improvement in their symptoms. Of significance, none of the patients who waited incurred any serious consequences, and none of the patients who had surgery had disastrous results. Although the researchers could not identify a definitive course of treatment, results of the study suggest that patients can be given a choice of which treatment option they would prefer.

Kolata G. Study questions need to operate on disk injuries. New York Times. November 22, 2006. Available at: http://www.nytimes.com/2006/11/22/health/22spine .html?_r=1&oref=slogin. Accessed November 22, 2006.

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