Disc Herniation and Sciatica Non-Surgical Care Safe and Equally Effective

A major new US trial of surgical vs nonoperative treatment for back pain and radiating pain from lumbar disc herniation published in the Journal of the American Medical Association on November 22, 2007, is the first large, well designed trial comparing surgery for sciatica with waiting. It led to extensive media coverage because of its quality, because the researchers were senior medical figures in the US (lead author is Dr. James Weinstein from Darthmouth Medical School, Hanover, New Hampshire, editor of the ‘Journal Spine’), and because the study reported important results challenging much conventional thinking.

The results were that patient with disc herniation recover almost equally as well with surgical as non-surgical care; that even where there is severe sciatica there is no risk of significant harm through opting waiting and non surgical care; and that patient choice is important and should be respected.

In this Spine Patient Outcomes Research Trial (SPORT) which enrolled eligible patients from 13 multidisciplinary spine clinics between March 2000 and November 2004; patients were 501 surgical candidates who were 18 years or older, and had intervertebral disc herniation and persistent symptoms of radicular pain for six weeks despite use of nonoperative treatments.

A prominent New York Times article on the trial on November 22 noted that “in the end….. neither waiting nor surgery was a clear winner and most patients could safely decide what to do based on personal preference and level of pain” and that “many surgeons had long feared that waiting would cause severe harm, but those fears were proved unfounded”. Senior surgeons were then quoted acknowledging that many doctors as well as patients feared harm if surgery was delayed – but that this study dispelled that fear.

* Weinstein JN, Tosteson TD et al. (2006) Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT): A randomizeed Trial, JAMA 296:2441-2450, Obervational Cohort, JAMA 296:2451-2459.

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