Generally when you have a health condition, early treatment is best. This is likely true for sciatica, a condition characterized by impingement of the sciatic nerve in the lower back. The sciatic nerve is the largest nerve in the body, extending from the lumbar vertebrae down the back of the leg to the foot on each side of the body.
The most common cause of sciatica is a herniated disc in the lumbar spine. Spinal discs are composed of a tough exterior and a gel-like center, similar to a jelly doughnut. Through wear and tear, improper body mechanics, excess weight or traumatic injury, the exterior of a disc can crack and the fluid center can leak out. This fluid contains inflammatory chemicals; if it makes contacts with the sciatic nerve exiting the spine, it can cause sciatica. Alternatively, if the exterior of the disc weakens but doesn't crack, the fluid may be pressed to the weaker side of the disc, and the bulge it creates can press against the nerve.
Early Treatment: Surgery?
One common treatment approach for herniated discs is discectomy. This may consist in a minimally-invasive procedure, called a microdiscectomy, in which a small incision is made and small amounts of disc material are removed. Some people, however, have larger and more invasive procedures.
Should patients seek out surgery right away with sciatica? Generally, the rule of thumb concerning back surgery is to leave it as a last resort. However, patients may be concerned that putting it off will worsen their prognosis. Fortunately, there has been research into this very question that can help patients make a decision.
Some research compares long-term results of conservative care versus surgery for sciatica; one study actually assesses whether duration of preoperative sciatica impacts outcomes.
A systematic review analyzed several studies that sought to compare long-term outcomes of surgery versus conservative/usual care, two of which had low bias risk. In one, patients who had severe sciatica for 6 to 12 weeks were randomized into early surgery or conservative care groups. Thirty-nine percent of the patients in the conservative care group went on to have surgery after 19 weeks. Patients who received early surgery had quicker pain relief than those who forewent surgery. However, at the one- and two-year follow-ups, both groups had similar, satisfactory outcomes.
Another, larger study with low bias risk suggested similar conclusions. At the two-year follow-up, patients who received surgery and those who did not had comparable improvement results on all measures. Forty-five percent of those originally placed in the conservative care group went on to have surgery. The two studies with high bias risk included in the review had similar results: no long-term differences in outcomes.
See more on these studies at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065612/#CR22.
Some patients in conservative care go on to have surgery. For these patients, does waiting harm their prognosis? A study released in 2014 concluded that it likely does not. Researchers categorized 240 patients according to whether their preoperative symptoms were present for more or less than one year. With a mean follow-up time of 33.7 months post-surgery, they found that the duration of symptoms prior to surgery had no significant impact on pain and disability outcomes. See more on this at http://www.ncbi.nlm.nih.gov/pubmed/24616807.
The decision to have or delay surgery for sciatica should depend on how severe the symptoms are. Based on the state of the research, patients should not fear that delaying surgery will worsen their prognosis. This is all the more reason to pursue conservative treatments, including physical therapy and inversion therapy, whenever possible.
Education in back pain is the cheapest form of self-preservation. Learn about what causes back pain and 4 things that cause sciatic nerve pain.
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