What are benefits of surgery for the management of lumbar disk disorders (LDDs) and sciatica?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Modern surgery for LDDs and sciatica are now characterized by small incisions, minimal blood loss, and early hospital discharge with postoperative convalescence lasting a few weeks compared with a few months typically seen in Weber’s study. Current surgical techniques are also associated with rapid pain relief and functional improvement in more than 70% of patients. [261, 262] Likewise, the relatively passive approach of nonoperative care differs from the more aggressive rehabilitative and functional restoration techniques that are currently advocated. [263]

A small, randomized, clinical trial of 56 patients with moderately severe sciatica of 6-12 weeks duration due to disk herniation showed more rapid improvement in leg pain and disability during the first 6-12 weeks in those randomized to the surgery group, with these comparative effects diminishing over time. [264] Similarly, a randomized clinical trial involving 169 patients reported better short-term outcomes with surgical treatment of disk herniation (up to 6 mo after surgery) compared with epidural steroid injections. [262] In these trials, the outcome differences between the surgical and nonsurgical groups rapidly diminished until they were essentially negligible after 2 or more years of follow-up. [260, 262, 264]


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