Study suggests that surgery may be superior treatment for chronic sciatica

In a randomized controlled trial from Lawson Health Research Institute, surgery was found to be superior to non-operative therapy in the treatment of chronic sciatica.

Chronic sciatica can be caused by a disc herniation which compresses a nerve in the lumbar spine causing pain from the lower back to the leg. The primary treatment options for sciatica are surgery or non-operative care. 

Dr. Chris Bailey, Lawson Associate Scientist and Orthopaedic Surgeon at London Health Sciences Centre (LHSC), and his colleagues conducted this study to test if a surgical treatment called microdiscectomy results in better patient outcomes for those with chronic sciatica compared to non-operative care. In Canada, non-operative care for chronic sciatica involves education, active physiotherapy, epidural injections and medications. 

The study included 128 patients with chronic sciatica treated at LHSC between 2010 and 2016.  

“Our results suggest there is a 70 per cent greater chance of significant improvement with surgery over non-operative care,” says Dr. Bailey. “In addition, we found that delayed surgery had an inferior outcome to expedited surgery.”

The findings suggest that surgical treatment results in better patient outcomes by improving function, quality of life and ability to return to work. The team hopes that this evidence can help clinicians and patients in making decisions about treatment for chronic sciatica.

With the data from this study, Dr. Bailey and his team are performing a number of follow-up studies including one that aims to predict who will respond to non-operative care and who will not. 

The study, “Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months,” is published in the New England Journal of Medicine. This study was funded by The Physicians’ Services Incorporated (PSI) Foundation and the Lawson Internal Research Fund (IRF).