Lumbar Disc Herniations: Surgical versus Nonoperative Care

  • Is anyone as frustrated as I am with persistent sciatica pain? For the past 15 years, my right leg frequently experiences shooting pain, aching pains, and sharp pains. Sound familiar? And maybe like me, you have a herniated lumbar disc at the root of the problem, literally. So when a study comparing surgical versus non-operative care of lumbar disc herniation comes out, I pay attention to the results.


    The recent SPORT (Spine Patient Outcomes Research Trial) study has published many results about treatment outcomes. For example, the results of an eight year randomized trial evaluating operative versus nonoperative care for lumbar disc herniations was just published. In this study, the people eligible for inclusion had lumbar radiculopathy that was persisting at least 6 weeks that had corresponding lumbar disc herniation. Even though people were randomized into “intent-to-treat groups,” people were eventually allowed to crossover into other treatment groups. In other words, people could pick and choose whether to have surgery or not.

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    People were eligible for surgery as long as the bone had no evidence of fracture, infection or deformity. Those with cancer were excluded from surgery as well. And those that did not have adequate non-operative care were not allowed to have surgery either. Overall, the spine patients with lumbar disc herniations that had surgery experienced better outcomes than those that did not. The sciatica symptoms especially improved following surgery. These results are consistent with other studies in the past that have compared operative versus nonoperative care for herniations causing sciatica.


    In the group that did not have surgery, improvements were still realized but not as dramatically as seen in those that had surgery. In fact, within 8 years, nearly 25% of the nonoperative group “crossed over” and had surgery. Those people must have been as frustrated as I am with persistent sciatica pain.


    Probably the most important result from this study is the fact that the improvements in both groups, operative and nonoperative, remained consistent through the years and did not get worse or degrade over the 8 years of this study. From my own personal experience, I concur. Yes, I improved with nonoperative care that focused on health, and no I have not gotten worse over the past 15 years. It’s the next 30 years that I am worried about. How about you?





    Spine (Phila Pa 1976). 2014 Jan 1;39(1):3-16

Published On: February 12, 2014