Surgical and Nonsurgical Options for Herniated Discs

Discectomy led to improved pain relief and disability symptoms

(RxWiki News) Herniated discs can be painful and even result in disability. A recent study looked at the benefits of spinal surgery as treatment for these slipped discs.

This study involved patients who chose surgery and others who chose nonsurgical treatment.

The researchers found that surgery was better at relieving pain and disability in patients who had a herniated disc. However, the majority of patients who chose nonsurgical treatment reported satisfaction with their symptoms and their care.

"Talk to your doctor about treatment options for herniated discs."

Jon Lurie, MD, MS, of the Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, led this study.

Spinal disc herniation, often called a "slipped disc," occurs when a spinal disc tears, allowing part of the disc to bulge out.

Disc herniations can cause sciatica, which is irritation of the sciatic nerve that causes pain and numbness.

Some patients with disc herniations choose to undergo a discectomy — a surgery to take out the herniated disc.

To evaluate whether surgery was more helpful than nonsurgical treatment for herniated discs, researchers conducted the Spine Patient Outcomes Research Trial (SPORT).

Participants included patients with disc herniation and nerve irritation.

SPORT involved a trial, in which some participants were randomized to have surgery, and an observational cohort, in which the researchers tracked patients but did not assign interventions.

Over the eight-year period, 820 patients underwent a discectomy while 424 were prescribed physical therapy, education and/or nonsteroidal anti-inflammatory drugs (NSAIDs).

The researchers followed up with the patients on their pain and disability levels, self-reported improvement, work status, satisfaction with their care and sciatica.

The most common complication during surgery was dural tearing, which is damage to the tissue covering the spinal cord. A dural tear occurred in 3 percent of the surgeries.

The researchers found that, for patients with a herniated disc that lasted for at least six weeks, surgery was better at relieving symptoms.

Sciatica pain and satisfaction improved more among the trial participants who were assigned to surgery.

The non-surgery group also improved substantially throughout the course of the study. By the eight-year mark, 54 percent reported satisfaction with their symptoms, and 73 percent were satisfied with their care.

The authors of this study noted that about half of the patients assigned to the non-surgery group in the trial ended up receiving surgery.

This study was published in Spine on January 1.

The research was funded by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the Office of Research on Women's Health, the National Institutes of Health and other health organizations. The researchers did not disclose conflicts of interest.

Review Date: 
January 2, 2014