Houston Methodist. Leading Medicine

General Spine News

Defining Best Treatments for Sciatica

The usual treatment for back pain with signs of paralysis from a disc problem is surgery. Numbness, muscle weakness, and loss of movement have generally been red flags in this condition. Surgery is often recommended in these cases. A new study has been published to challenge this widely accepted practice.

Seventeen different groups of doctors participated in this study. Patients with leg pain or sciatica from the disc pressing on a spinal nerve root were observed. Half were treated with surgery to remove pressure from the nerve root. The other half received nonsurgical treatment.

Both groups were measured at one, three, and six months for pain level, muscle strength, return to work status, and use of pain medication. Recovery rates were equal for both groups (around 70 per cent). If both treatments work equally well, what are the important factors to predict recovery?

The only difference between those who got better and those who didn't for both treatments is age. Younger patients are more likely to recovery fully no matter which treatment is used. Return to work was based on whether or not the patient had improved enough or recovered fully.

Surgical treatment of sciatica with signs of paralysis isn't always more effective than medical management without surgery. This is a new finding about a standard treatment used for years. More studies are needed to confirm this finding. Complete paralysis still usually requires immediate surgery.


Genevieve Dubourg, MD, et al. A Pilot Study on the Recovery From Paresis After Lumbar Disc Herniation. In Spine. July 1, 2002. Vol. 27. No. 13. Pp. 1426-1432.

07/31/2002

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