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Surgery for sciatica should be optional

BMJ 2007; 334 doi: (Published 07 June 2007) Cite this as: BMJ 2007;334:1188

Patients with enduring sciatica caused by a herniated intervertebral disc can have a microdiscectomy or more conservative treatment, with the option of later surgery if symptoms don't improve. After a year, the results were similar for both treatments in a recent trial. More than 90% of patients in both groups recovered. But those who had an early microdiscectomy got better significantly faster (median time to recovery 4.0 weeks, 95% CI 3.7 to 4.4 v 12.1, 9.5 to 14.9). The main advantage of early surgery was faster recovery from leg pain. The authors used validated scales to measure disability, pain, and patients' global perception of recovery.

All the participants had had sciatica for six to 12 weeks before the trial began. Patients assigned to surgery had a microdiscectomy with a median delay of less than two weeks. The rest were encouraged to stay mobile and given analgesics and physiotherapy if needed. Almost 40% (55/142) of them had surgery eventually—after a median of 14.6 weeks.

Patients with sciatica should be reassured that the long term prognosis is reasonably good, even with conservative treatment, say the authors. Patients who don't want surgery can safely wait and see if they recover spontaneously. For those who can't wait, early surgery might be best.


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