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Surgery early on to treat sciatica relieves pain more quickly than nonsurgical treatemnts, according to a study in the May 31 New England Journal of Medicine. But almost all people with sciatica had recovered completely a year later, whether they had surgery or not. Sciatica, pain that radiates down the back into one leg, is caused by a protruding disk in the lower spinal column that presses on the sciatic nerve. It can feel like a bad leg cramp that lasts for weeks, or like "pins and needles." It's very common; about 5 in 1,000 adults get sciatcia each year.
Researchers led by Wilco Peul at the Leiden University Medical Center in the Netherlands randomly assigned 283 patients who hda severe sciatica to either surgery or prolonged nonsurgical treatment, with surgery if necessary. The researchers found that 95 percent of the people in the study felt better after a year, whetehr they had surgery or not. But the 125 people who had early surgery to remove the herniated disk reported feeling better twice as fast as the nonsurgery group. During that time they reported less back and leg pain and less disability. Thus the major benefit of surgery is having faster relief from teh pain of sciatica.
Of the 142 patients assigned to conservative treatment, which incldued pain medication such as ibuprofen and physical therapy, 55 underwent surgery during the first year because of pain. All told, 89 percent of the early-surgery group and 39 percent of the conservative treatment gorup had back surgery within the year. A little lses than 2 percent of surgical patients suffered compilcations; all recovered.
People are most likely to get sciatica in their 30s to 50s, and 80 to 90 percent get better over time, without surgery. Most recover on their own within three months. This new study emphasizes that people who want to postpone surgery won't reduce their chances for a complete recovery in a year, while those who feel they can't cope with the pain can justify surgery as a method to reduce recovery time.
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