Best management of sciatica (leg pain, numbness, tingling, or weakness) caused by a herniated disc in the lumbar spine is challenging. We spine surgeons incorporate several factors into our decision-making: severity and duration of symptoms as well as imaging findings just to name a few. At East Bay Brain & Spine/BASS Neurosurgery we aim to avoid surgery when a patient will likely improve with physical therapy and other “conservative” treatments. On the other hand, we perform surgery when discectomy will improve a patient’s pain, numbness/tingling, and strength outcome.
This recent study from the New England Journal of Medicine studies patients (a randomized trial) who have sciatica from a herniated disc and do not undergo surgery right away. When these patients do undergo discectomy surgery four to twelve months from when the leg symptoms began, their sciatica, back pain, and level of disability improve as compared to others who were assigned physical therapy, epidural steroids, or other non-surgical treatments.