Surgery Only Slightly Better for Herniated Disc

Many patients with sciatic pain improve with other methods, studies find.

By Amanda Gardner
HealthDay Reporter
Tuesday, November 21, 2006; 12:00 AM

Copyright © 2006 ScoutNews, LLC. All rights reserved.

TUESDAY, Nov. 21 (HealthDay News) -- Is surgery for sciatica resulting from herniated discs worth it?

The answer seems to be a cautious "yes," with experts noting that, for many patients, non-surgical methods may work just as well.

Two related studies, using different methodologies, found that back surgery did produce slightly better outcomes than non-surgical treatment. Both studies are published in the Nov. 22/29 issue of the Journal of the American Medical Association.

"The bottom line is that surgery works," said Dr. Todd Albert, co-author of one of the studies and vice chairman of the department of orthopedics and president of the Rothman Institute at Thomas Jefferson University in Philadelphia. "Non-operative treatment can work, and people can do well with it, but surgery worked better."

But surgery is definitely not for everyone, added another of the study's authors, Dr. Alan S. Hilibrand, associate professor of orthopaedic surgery at Jefferson Medical College.

"The person who comes in with leg pain from a herniated disc has a good chance of getting better with non-operative treatment and, unless they have certain unusual things going on, they should be treated non-operationally initially," he said. "If they're not getting better, they're likely to do well with surgery."

In fact, in general, the procedure should be reserved for herniated discs causing leg pain (sciatica), not for back pain caused by degenerated discs, Hilibrand explained.

Herniated discs occur when the nucleus of a spinal disc -- the cushioned part of the spine -- pushes into the spinal canal due to a tear or rupture. Many people recover from herniated disc on their own, but others require operations.

As the study points out, there are high variations in rates of this operation in the United States and, generally, lower rates internationally. That raises the question of whether and when it is appropriate to perform the procedure.

For the first study, close to 500 patients with herniated disc and sciatica were randomly assigned to undergo surgery or receive non-operative treatment, which included physical therapy and counseling.