Some individuals with low back problems develop referred leg symptoms from a pinched nerve which is called "sciatica." This is usually the result of a herniated disc in the lumbar spine area pressing on the nerve as it exits the spin heading down into the leg.
When a pinched nerve is involved, the symptoms are usually more severe, and the problem takes longer to resolve although most cases will settle down within 12 weeks on conservative, non-operative care. Patients with sciatica tend to have more symptoms in their leg (from referred pain secondary to the pinched nerve in the back), than in their lower back itself. Sometimes there is associated weakness in the lower leg, foot or ankle.
So why is there so much low back surgery being done in our nation? There are indeed certain conditions involving the lower back or lumbar spine that do require surgery. These include fractures, instability, and cases in which there is severe nerve compression resulting in progressive weakness and/or problems with our bladder function (something called cauda equina syndrome).
For routine backache or mild cases of sciatica back surgery is rarely warranted. Unfortunately, many individuals with these problems still have back surgery.
Two recent studies published in JAMA (the Journal of the American Medical Association) suggests that individuals with sciatica that don't have surgery tend to do just as well as time goes on as those who have had surgery. The recovery may be quicker for those who have surgery but the longer-term results seem equal. I am not certain we can draw perfect conclusions from these studies since many of the patients who were randomly assigned to the non-operative care chose to have back surgery because of their symptoms.
This muddies the water a little in terms of interpretation but I think the overall message is still quite clear, that if you have backache associated with sciatica, and there are no serious neurological issues, you certainly do no harm in waiting rather than jumping right in to surgery.
I am not saying to ignore your back (or leg) symptoms and just wait it out. I am also absolutely not saying that surgery is never needed. You should still get things checked out medically. Your doctor or other health care professional can recommend things to help speed your recovery, make you more comfortable, and most importantly offer some preventive measures to avoid future back attacks. This is important because unfortunately once you have a back episode, you're much more likely to have another.
What has worked for your back attacks? Have you had back surgery? And how has it worked out for you? Share your thoughts.
