Surgical and nonsurgical management of sciatica secondary to a lumbar discherniation - Five-year outcomes from the Maine Lumbar Spine Study

Study Design. A prospective cohort study. Objective. To assess 5-year outcomes for patients with sciatica caused by a lumbar disc herniation treated surgically or nonsurgically. Summary of Background Data. There is limited knowledge about long-term trea tment outcomes of sciatica caused by a lumbar disc herniation, particularly the relative benefits of surgical and conservative therapy in contemporary clinical practice. Methods. Eligible, consenting patients recruited from the practices of orth opedic surgeons, neurosurgeons, and occupational medicine physicians throug hout Maine had baseline interviews with mailed follow-up questionnaires at 3, 6, and 12 months and annually thereafter. Clinical data were obtained at baseline from a physician questionnaire. Outcomes included patient-reporte d symptoms of leg and back pain, functional status, satisfaction, and emplo yment and compensation status. Results. Of 507 patients initially enrolled, 5-year outcomes were available for 402 (79.3%) patients: 220 (80%) treated surgically and 182 (78.4%) tre ated nonsurgically. Surgically treated patients had worse baseline symptoms and functional status than those initially treated nonsurgically. By 5 yea rs 19% of surgical patients had undergone at least one additional lumbar sp ine operation, and 16% of nonsurgical patients had opted for at least one l umbar spine operation. Overall, patients treated initially with surgery rep orted better outcomes. At the 5-year follow-up, 70% of patients initially t reated surgically reported improvement in their predominant symptom (back o r leg pain) versus 56% of those initially treated nonsurgically (P < 0.001) . Similarly, a larger proportion of surgical patients reported satisfaction with their current status (63% vs. 46%, P < 0.001). These differences pers isted after adjustment for other determinants of outcome. The relative adva ntage of surgery was greatest early in follow-up and narrowed over 5 years. There was no difference in the proportion of patients receiving disability compensation at the 5-year follow-up. The least symptomatic patients at ba seline did well regardless of initial treatment, although function improved more in the surgical group. Conclusions. For patients with moderate or severe sciatica, surgical treatm ent was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased ove r time.