Back Pain Often Ends Without Surgery

May 30, 2007 -- For two specific kinds of back and leg pain, back surgery offers the fastest relief -- but those who choose nonsurgical treatments get better, too.

Two separate studies reported in this week's New England Journal of Medicine show that surgery is the fastest route to pain relief for two very different conditions: severe sciatica and degenerative spondylolisthesis.

But the studies also show that these conditions do not worsen if surgery is delayed -- and that nonsurgical treatments can relieve at least some of the pain.

An editorial titled "Back Surgery: Who Needs It?" accompanies the studies. Editorialist and back pain researcher Richard A. Deyo, MD, MPH, is professor of medicine and director of the center for cost and outcomes research at the University of Washington in Seattle.

"The people who truly need back surgery are those who need it to preserve their ability to function," Deyo tells WebMD. "But short of that, most back surgery is an elective procedure. It is not urgent. Patients face real choices that are quite reasonable: either surgical or no surgery."

Sciatica: Surgery vs. No Surgery

Sciatica is pain or tingling that begins in the back or buttocks and runs down the leg. The most common cause is a bulging disk in the spine. The bulge presses against a nerve root, causing problems all along the nerves that branch from that root.

Surgical treatment of sciatica relieves pressure on the nerve root by removing a portion of the affected spinal disk. But sciatica often gets better over time. Is surgery really the best choice? How long should a patient wait before opting for surgery?

To answer these questions, neurosurgeon Wilco C. Peul, MD, head of the spine intervention study group at Leiden University Medical Center in the Netherlands, led a study of 283 patients with confirmed cases of severe sciatica.

All of these patients' symptoms had lasted for six to 12 weeks. Even with pain medication, they could barely walk and were not able to work around the house or at their normal jobs.

Half the patients underwent early surgery, most within two weeks of study entry. The other patients were assigned to "conservative treatment," which included pain management and physical therapy.

As expected, early surgery meant quicker recovery. But Peul and colleagues were surprised by what happened in the conservative-treatment group.

"The most important result is that what we did not expect -- that in the conservative-treatment group, most of them also had a quick recovery," Peul tells WebMD. "It was slower than the early-surgery group. And 39% had longer-lasting leg pain and needed surgery. But at one year, the results for the two groups are nearly equal. Even at three and six months, the outcomes were not that much different."