Is Surgery for Sciatica Really Worth It?
Sciatica can send searing, unrelenting pain down your legs, and surgery is often recommended if other less invasive measures fail to bring relief.
Unfortunately, a new study review suggests that such operations likely only provide temporary results, with pain typically returning within a year.
Sciatica is “characterized by pain going down the back of the leg, most often due to pressure on a spinal nerve root caused by a ruptured spinal disc in the lower back," said study author Christine Lin, a professor with Sydney Musculoskeletal Health at the University of Sydney in Australia. "The condition can also manifest as back pain, muscle weakness, and a pins-and-needles sensation in the lower leg.
“We set out to investigate if surgery was effective in relieving pain and disability in people with sciatica caused by a ruptured [spinal] disc,” said Lin.
But after reviewing 24 prior studies, she and her colleagues concluded that while partial removal of a ruptured disc (discectomy) did result in short-term pain and disability relief, “the benefits reduced with time, and at one year there were no treatment benefits compared to people who did not have surgery.”
Lin noted that while surgery is not the only intervention for sciatica patients, “we don't have a lot of treatment options that are backed by scientific evidence.”
There is only “limited evidence” suggesting that an exercise program (physical therapy) is helpful. In a similar vein, Lin said, there is little evidence that drugs -- including steroids injected directly into the lower back -- are effective at providing substantial pain relief.
So many patients opt for surgery, said Lin, despite the risk for disc tears and wound complications.
To assess the relative effectiveness of surgery, Lin's team reviewed two dozen studies that had previously compared the potential benefits of surgery versus non-surgical options for sciatica patients whose condition was caused by a herniated disk.
Half of the studies specifically examined surgical outcomes following a discectomy procedure. Non-surgical options included steroid injections and/or sham surgery or sham treatments.
The studies variously tracked pain relief outcomes for periods of up a year following treatment.
In the end, Lin and her colleagues determined that the evidence that discectomy surgery was more effective at reducing leg pain than non-surgical options was “very low” to “low.”
The team further noted that what evidence there was did suggest that surgery was better than non-surgical options when it comes to providing “moderate” pain relief within three months post-surgery.
But after three months -- and up until a year out -- surgery's ability to provide better pain relief than non-surgical options was found to be relatively “small.” And no significant pain relief benefit was observed a full year after surgery was performed.
The team acknowledged that the studies under review were conducted under different conditions, which could affect the criteria by which patients were deemed eligible for surgery. In addition, study discussions of non-surgical outcomes were often found to be lacking in quality.
Lin said that the review result, published April 19 in the BMJ, “wasn't completely surprising, as previous research had similar findings.”
Even so, she stressed that most people with sciatica do get better over time, so for many patients the short-term relief that surgery can afford “might still be worthwhile,” if patients and surgeons decide to go that route.
Could some patients gain more from surgery than others? Lin said that for the moment, “we don't have enough information” to know.
But her bottom line is that “surgery could be considered as an early treatment option, which may be important for those patients for whom rapid pain relief might be a priority and who think that the short-term benefits of surgery outweigh the potential risks and costs of surgery.”
Annina Schmid, who co-wrote an editorial published with the review, is head of the neuromusculoskeletal health and science lab in the Nuffield Department of Clinical Neurosciences at Oxford University in England.
She seconded the observation that most sciatica patients -- roughly 7 in 10 -- will “recover spontaneously,” regardless of whether they opt for physical therapy, medications or surgery.
“So, what this study shows is that at long term, both surgery and conservative care provide comparable symptom relief,” said Schmid.
The Cleveland Clinic has more on sciatica.
SOURCES: Christine Lin, PhD, professor, Sydney Musculoskeletal Health, faculty of medicine and health, University of Sydney, NSW, Australia; Annina Schmid, PhD, associate professor and head, neuromusculoskeletal health and science lab, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, U.K.; BMJ, April 19, 2023, online