This is the second in a three-part piece looking at sciatica, the pain affecting the back, hip and outer side of the leg, which is caused by compression of a spinal nerve root in the lower back.

RESEARCHERS at multiple centres recruited 283 patients with persistent symptoms of sciatica lasting six to 12 weeks and randomised them in a study comparing early surgery versus prolonged conservative therapy. All the patients had a herniated disk on their MRI scans, and scans were performed at the beginning of the study as well as one year later. The question was whether there is an association between what we see on the MRI scan and the eventual clinical outcome. Did the pain go away, and was the patient happy with the outcome?

At one year, 84 per cent of the patients had a favourable outcome, whether they had surgery or conservative treatment. Previous studies had reported that those who have surgery occasionally get better faster (while many take much longer to recuperate), but at one year, there is simply no difference between surgery and alternative approaches. Except, the surgical patients now had side effects and usually apparatuses left in their bodies. The disk pressing on the nerve root that was thought to cause the pain down the leg had disappeared on the MRI scan in 82 per cent of people having surgery. But, it also disappeared in at least 60 per cent of those who had conservative therapy. This means they had non-invasive treatment, such as chiropractic care.

This shows that herniated disks can get smaller and disappear, even without surgery; especially with natural care, such as chiropractic alignments. The study also looked at those patients who still had a disk herniation on their MRI scan at one year, and there was no significant difference. Eighty-five per cent of those with a disk herniation on their MRI scan at one year still had a favourable outcome, as compared to 83 per cent with no disk herniation. And, of course, this was in reality no better than those who progressed with conservative care.

Of course, it is not so simple as to just assume that something is pressing on the nerve and causing the pain. How many times have you heard someone say that they had a “slipped disk”? It sounds good, but it doesn’t work that way. Discs do not slip. The vertebrae slip out of position and the disc travels with it. But pain may also be from inflammation, a chemical reaction, or some other process that causes the pain. The truth is that the source of a person’s low back and leg pain is frequently illusive and/or elusive.

The bottom line: When trying to decide who should have surgery, a herniated disk or nerve root compression on a MRI scan does not predict a better outcome. This study even looked at those situations where a piece of disk has broken off (an extrusion) and there was no difference. It is difficult to correlate a patient’s symptoms with the findings on their MRI scan. The best advice that can be given to anyone is that unless it is an extreme, emergency case, where one has lost function of extremities, bowels, bladder, sex organs, etc, then it is always best and safest to try the most natural conservative way first.

Surgery should not be attempted before pain management, and neither drugs nor surgery should be attempted before chiropractic. When done properly, chiropractic care can negate the urgency for drugs and surgery in up to 85 per cent of all cases. When attempted in reverse, there is usually little natural care can do to overcome or improve the invasive damage caused by surgeries.

Don’t forget to “Ask Your Chiropractor” every week where your questions may be published and answered in subsequent articles. Address questions to: Dr Chris Davis, the Spinal Mechanic at movethebone@gmail.com; or, Dr Michael Harvey, director, at dr.michael_harvey@yahoo.com