Back and leg pain (sciatica) affect many Americans every year. Despite how common the disorder is, the best treatment for the problem still remains unknown. In this study, the results of two different treatments are compared.

Patients with lumbar disc protrusion causing radiculopathy were treated in one group with surgery. The second group had nonoperative or nonsurgical care. Radiculopathy refers to the symptoms that occur when the protruding disc puts pressure on the spinal nerve. Patients report back and leg pain, numbness and tingling (or a pins and needles sensation) down the leg, and weakness.

Surgery consisted of a lumbar microdiscectomy. In this procedure, the surgeon uses a minimally invasive method to remove the disc. For the nonoperative group, care followed guidelines set by the North American Spine Society (NASS). The nonoperative treatment protocol was not described for this study.

There was not a significant difference in the outcomes between the two groups. Both groups got better over time. In general, patients in either group never returned to normal. This means that test measures for function and quality of life were lower for anyone with back and leg pain compared to people their age who did not have pain from radiculopathy.

The authors conclude that the type of treatment received for low back pain with sciatica is not linked with results. And secondly, no matter what kind of treatment is used, some disability persists for most patients.

These results were not consistent with the outcomes of other, similar studies.
The authors suspect the delays in treatment with this government-insured health care may have changed the results. More study is needed to continue sorting out what treatment works and when is the best time to apply that treatment for this problem.

Kenneth C. Thomas, MD, MHSC, FRCSC, et al. Outcome Evaluation of Surgical and Nonsurgical Management of Lumbar Disc Protrusion Causing Radiculopathy. In Spine. June 1, 2007. Vol. 32. No. 13. Pp. 1414-1422.