Low Back Pain and Sciatica and Diskectomy

A diskectomy is the removal of the protruding disc and part of the backbone and is done to potentially cure some of the pain associated with sciatica. The doctor makes an incision in the back, then a small part of the bone is removed to obtain access to the disc. The disc is then removed to take pressure off the nerve.

In certain cases, the doctor can perform a microdiskectomy to remove a herniated disc. A microdiskectomy is a less invasive procedure. The doctor makes a smaller incision and uses a magnifying instrument to visualize the disc and nerves. However, it is not always possible to do a microdiskectomy.

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In a randomized clinical trial patients with radicular pain and image-confirmed lumbar intervertebral disc herniation were assigned standard diskectomy or a variety of nonoperative treatments. Over two years, both groups showed substantial improvements. Some secondary outcome analyses favored surgical treatment. There were study limitations that could have influenced the outcome.

A clinical trial published in 2007 by Peul, et al., studies early versus delayed microdiskectomy. Patients with severe sciatica were randomly assigned to receive early microdiskectomy (within an average of 2.2 weeks) or conservative treatment (ie, combination of rest, physical therapy, and medications) with delayed surgery if necessary. Although after one year there was no difference in pain or disability between the two groups, those patients receiving early surgery reported significantly faster recovery. However, of the patients who were in the delayed group, only 39% eventually required surgery.

Several studies have attempted to look at the effects of surgical diskectomy versus nonoperative treatments (for example, lifestyle changes, dietary changes, and herbal substances to lower inflammation). Many of these studies find that patients improve with either surgical or nonoperative care. Over time, results may be similar for either group, and while there is a trend suggesting that patients improve faster with surgery, the studies have imperfections that limit direct comparison of surgery versus nonoperative treatment.

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