Does surgery relieve the pain of a herniated disc?
Surgery improves leg pain, not disability, more than conservative therapy
Another RCT also directly compared microdiscectomy to conservative treatment in 283 patients with confirmed LDH and symptoms lasting 6 to 12 weeks.7 The surgical group underwent microdiscectomy within 2 weeks of randomization. Pain and disability measurements, based on standardized scales, showed significant improvement in leg pain (P<.001) for the surgical group, but no significant difference in disability.
Patient perception of recovery on a Likert-type scale showed a median recovery time of 4 weeks for the surgical group and 12 weeks for the conservative therapy group. No significant differences in perceived degree of recovery were noted between the groups at 1 year; 95% of participants had a satisfactory recovery.
Again, significant crossover occurred: 11% of patients allocated to surgery recovered before surgery, and 39% of the conservative therapy group experienced worsening symptoms or intractable pain that led them to undergo microdiscectomy.
Open discectomy, microdiscectomy produce similar results
A Cochrane review of interventions for LDH included only the Weber2 and SPORT3 RCTs. The review also included 3 RCTs that compared open discectomy and microdiscectomy. These studies found no difference in pain relief or complications between the 2 interventions.8
Recommendations
The Institute for Clinical Systems Improvement guidelines for adult low back pain list cauda equina, progressive neurologic deficits, or uncontrolled pain as reasons for direct referral to a spine specialist.1 Patients can be treated conservatively for 6 weeks without imaging, unless other symptoms or concerns are present.
The guidelines recommend that patients with chronic sciatica (lasting >6 weeks) receive further imaging or referral to a specialist if the patient is a potential candidate for surgery.
