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When to Stop Theray and Opt for Surgery

After months of sciatic pain, I finally caved and had surgery. My surgeon assured me that this is not uncommon, but I still felt like a failure. How often do patients give up on therapy and go for the surgery?

Conservative (nonoperative) care is often advised for sciatica. This is because so many studies show that after six to eight weeks, most cases of back pain radiating down the leg go away completely.

But that isn't always the case. Sometimes people just don't get better. Some even get worse. In the presence of severe pain or motor symptoms (muscle weakness, paralysis), surgery is indicated. And making the decision to have surgery doesn't label you a failure.

The medical community would say that in your case (or cases like yours), the outcomes of conservative care weren't satisfactory. That's a signal to explore other options, including surgery. Approximately 40 per cent of patients fall into this category of crossing over from nonoperative to operative treatment. Most do so after 12 to 14 weeks of conservative care.

There's even some research to suggest that recovery is better and faster for patients who have surgery early in the course of their sciatica (within the first two weeks after onset of symptoms). That goes against everything we've been told about the importance of following a prolonged course of nonoperative care before considering surgery.

So, clearly there are factors that remain unknown in predicting the success or failure of treatment for sciatica. More studies are needed to define just what these factors are and help patients navigate nonoperative care versus surgical management and the timing of both.

Wilco C. Peul, et al. Influence of Gender and Other Prognostic Factors on Outcome of Sciatica. In Pain. August 2008. Vol. 138. No. 1. Pp. 180-191.