Surgery and non-surgical options both helped relieve pain from herniated discs

The first results of a study of 1,244 patients with lumbar disc herniations showed that the use of surgery or non-surgical interventions equally improved their sciatic symptom.

The long-awaited findings from the Spine Patient Outcomes Research Trial (SPORT) were published in the Journal of the American Medical Association Nov. 22.

Regardless of whether the patients in the study underwent surgery or not, they all demonstrated considerable improvement in functionality and quality of life at one and two years after the onset of symptoms. However, patients with the most severe pain relative to disc herniation appeared to have better outcomes with surgery.

Investigators based the criteria for improvement on changes in the Oswestry Disability Index, sciatica symptoms, the patients' satisfaction with their symptoms and their self-rated improvement.

"What we found is that for patients who come to us with severe back and leg pain and have surgery, there is an advantage in terms of how they feel overall one and two years out from the surgery," James N. Weinstein, DO, lead author of the study, said in a press release. He noted that when patients can and are willing to tolerate the pain, non-surgical treatments can be very effective.

According to the study results, physical therapy, over-the-counter medication, chiropractic care and injection were among the non-surgical options used by the study subjects.

Weinstein is chairman of the department of orthopedics, Dartmouth Medical School and Dartmouth-Hitchcock Medical Center, Lebanon, N.H.

For the study, 501 patients enrolled in the SPORT were randomized to undergo either a lumbar discectomy or nonoperative care to treat their back and leg pain. Another group of 743 patients formed an observational group who could choose their treatment, but were followed prospectively. Ultimately, 760 patients had surgery and 484 did not.

The results may not be conclusive nor answer to the question of how to best treat lumbar disc herniations because a number of patients in both arms of the randomized portion of the study crossed over into the other treatment arm. "However, at every stage, the authors observed that patients who had surgery reported better outcomes," according to the press release.

These are the first data from the study involving 142 U.S. physicians at 13 sites in 11 states. Next year the cost-effectiveness portion of the study is due to be released.

For more information:
Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs. nonoperative treatment for lumbar disk herniation. JAMA. 2006;296:2441-2450.