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Sciatica surgery no better for relief of back pain, function

A pair of studies indicate that patients improve just as well with other treatment .

By ASSOCIATED PRESS
Published November 22, 2006

CHICAGO - Two big government-funded studies on back surgery for painful herniated disks show no clear-cut reason to choose an operation over other treatment.

The pain and physical function of the patients, who were suffering from sciatica, improved significantly after two years whether or not they had surgery. However, neither strategy offered complete relief.

The results indicate patients should choose which treatment they get for the ailment, the researchers said.

"In back surgery for this particular condition, there's actually a choice," said the lead author Dr. James Weinstein of Dartmouth Medical School. "If you don't want the risk of surgery, you can do watchful waiting" and still get well.

The condition involves disk cartilage bulging between vertebrae in the lower spine and pressing against a nerve. It can cause excruciating burning pain called sciatica, radiating from the lower back into the legs; patients often have difficulty walking.

About 250,000 Americans have disk surgery for sciatica each year, while another quarter-million instead choose physical therapy, painkillers or rest until they feel better. The surgery costs about $6,000, Weinstein said.

The findings, published in the Journal of the American Medical Association, are the first from a big government-funded research project on spine surgery. Patients were treated at 13 spine centers in 11 states.

One study involved 472 patients aged 42 on average who were followed for two years after being randomly assigned to surgery or noninvasive treatment, which included education, physical therapy or painkillers. Surgery involved removing part of the bulging disc in a standard operation.

Patients in both groups had much improved scores on measures of pain, physical function and disability during periodic evaluations; differences between the groups weren't statistically significant.

Ninety-five percent of surgery patients had no complications, but 4 percent required a second surgery within a year.

In the other study, the researchers followed for two years 743 patients who chose surgery or other treatment. It found a clearer advantage to surgery, including quicker relief in the first months. After three months, 82 percent of surgery patients reported major improvement, compared with 48 percent of nonsurgery patients. Those differences shrank over two years, however.

[Last modified November 22, 2006, 01:04:34]