The pain condition sciatica is triggered when an injury or misalignment of the spine interferes with the nerves that run from the lower back down each leg. Often this interference is caused by a herniated disc. Patients suffering from sciatica whose symptoms don't improve after initial treatment with painkillers are often recommended to undergo spinal decompression surgery, also known as microdiscectomy. Over 300,000 microdiscectomies are performed every year in the United States, but in 10-20% of cases, surgery does not relieve the original pain symptoms. Other patients opt to use the services of a chiropractor who performs spinal manipulation.
Researchers in Canada conducted a pilot clinical trial to compare the effects of surgery versus spinal manipulation on 40 patients with sciatica caused by lumbar disc herniation (LDH). Patients participating in the study had not seen improvement in their sciatica symptoms after at least 3 months of trying nonoperative health therapies, including lifestyle modification, massage, acupuncture, or painkillers. Half of the study participants were then randomly assigned to receive microdiscectomy surgery, while the other half went on to receive spinal manipulation. Patients from both groups attended six rehabilitation sessions after their assigned treatment. After 12 weeks, patients in both groups who were not satisfied with their results were given the option to switch treatment groups.
Among the patients who were assigned to the microdiscectomy group, 85% improved after the treatment. For those who received spinal manipulation, 60% saw clear improvement of their symptoms. The patients from this group who then opted for microdiscectomy saw the same improvement rates as those who initially had surgery, but this was not the case for those who opted for spinal decompression post-surgery.
The study findings suggest that that for more that half of people suffering from sciatica caused by a herniated disc, spinal manipulation will offer a noninvasive path to pain relief that is just as effective as surgery. Those patients who do not respond to chiropractic care will still have the option of surgery, and as the researchers conclude "the obvious risk and cost profile of operative care argues for serious physician and patient consideration of spinal manipulative therapy before surgical intervention." This research can help inform treatment options for patients with sciatica—although spinal manipulation may not be effective for all patients, it is a viable and cost-effective alternative to consider before surgery.
McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics. 2010; 33(8): 576-584.