In an earlier blog post, we explained what Sciatica is including typical signs and symptoms. In this blog post, we will explain the use of conservative care (i.e. chiropractic, acupuncture, physiotherapy and rehabilitation) versus surgery for sciatica treatment.
There was a study conducted with two groups of individuals who all had severe sciatica caused by disc herniation. The first group received surgical intervention within 2 weeks of symptom onset and the second group received conservative care for 6 months and only individuals that were not better went on to receive surgical intervention.
What did they find? The results of this study showed that the early surgery group and conservative care group were no different one year later.
What does mean? It is best to try conservative care first as you will likely get better with chiropractic, acupuncture, physiotherapy and rehabilitation. If you do not get better, surgery is still an option.
Some people believe there will be permanent damage in their spine and nerves if they take the conservative approach to management. Unless you have cauda equina syndrome, significant loss of muscle strength in the lower extremities and or significant sensory loss in both lower extremities then it is likely you will benefit from physical therapy or chiropractic care.
Severe sciatica can be difficult to treat conservatively and may take some time, however the timeline for surgical treatment is no better. It takes 6 months to get an MRI in many cases and another 6 months to schedule an appointment with an orthopedic surgeon. Following the orthopedic consultation you get scheduled in for surgery a few months later. That’s more than a year before you even get surgery and that is if you are even a candidate for surgery.
You are better off starting conservative management first and to try and avoid surgery. Most surgeons want to see some evidence that you have exhausted all options before they even consider doing surgery on you. Lower back surgery has one big caveat. Even though orthopedic surgeons do their best to pick and choose who are the real candidates, there is only a 50% success rate. Fusion surgery seems to have a higher success rate of 60-70% .
While the success rate of fusion surgery is higher there are consequences 10-15 years later. With fusion of two vertebrae you now effectively have one less vertebrae. Four vertebrae are now trying to do the work of five. This results in premature osteoarthritis that becomes severe within 10-15 years, usually resulting in restricted movements and more importantly pain.
Discectomy involves taking out the nucleus from the disc and sometimes part of the bones covering the disc called the lamina. (Laminectomy). This surgery seems to relapse more frequently. Among my patients that the pain-free effect can last a couple weeks for some, while others have lasted years with only low back pain returning or mild sciatica. My Recommendation is to always try conservative care first and you can always make arrangements for surgery while getting conservative care.
- New England Journal of Medicine 2007; 356(22): 2245-2256.