Surgery not always best way to relieve sciatica pain

By Stephen Beech via SWNS

Surgery is not always the best option to relieve the crippling pain of sciatica, according to new research.

And, even if going under the knife is successful, doctors say the benefits are often short-lived, lasting only up to 12 months.

Sciatica is pain that originates along the sciatic nerve, the largest nerve in the body, extending from the back of the pelvis down the back of the thigh.

It usually affects one side, starting from the lower back or bottom and spreading down one leg.

Symptoms of sciatica include shooting pain that starts in the lower back or bottom and runs down the back of the leg, often to the foot and toes.

Treatments to relieve pain include nonsteroidal anti-inflammatory medications, applying heat or cold and exercising to help minimize inflammation.

When the pain is caused by a slipped disc, surgery is often the treatment option for pain relief.

But analysis of the latest evidence, published by The BMJ, led the research team to suggest that surgery might only be a worthwhile option for people who feel that the rapid relief outweighs the costs and potential risks.

Current guidelines recommend surgery - known as discectomy - when non-surgical options, such as drugs or steroid injections, are unsuccessful.

While surgery is widely used, evidence for its use is still uncertain.

An international team of researchers set out to investigate the effectiveness and safety of going under the knife compared with non-surgical treatment for sciatica.

They searched databases for trials comparing any surgical treatment with non-surgical treatment, epidural steroid injections, or placebo, in people with sciatica of any duration due to a herniated disc.

Trial follow-up times were split into immediate term (six weeks or less), short term (between six weeks and three months), medium term (between three and 12 months), and long term (12 months).

A total of 24 trials involving more than 1,700 participants were included in the main analysis, half of which looked at the effectiveness of an operation compared with non-surgical treatment or epidural steroid injections.

Study author Professor Christine Lin said "very low to low" certainty evidence showed that going under the knife, compared with non-surgical treatment, reduced leg pain.

Prof. Lin, of the University of Sydney, Australia, said the effect size was "moderate" at immediate and short term, "small" at medium term, and "negligible" at long term.

And, in terms of disability, small, negligible, or no effects were found.

Prof Lin said: "A similar effect on leg pain was found when comparing discectomy with epidural steroid injections.

"For disability, a moderate effect was found at short term, but no effect was observed at medium and long term.

"The risk of any adverse events, such as wound infection, repeat disc herniation, and persistent postsurgical pain, was similar between discectomy and non-surgical treatment."

She said, generally, discectomy resulted in faster relief in pain and disability, but only up to 12 months - and might be considered an early management option in people in whom the benefits of early improvement in leg pain or disability outweigh the costs and potential risks.

The researchers noted that, fortunately, the majority of people with sciatica recover "spontaneously" without the need for surgery.

Prof. Lin added: "This review provides the most comprehensive synthesis of the evidence on surgical procedures for sciatica to date."