Re: Early surgery for sciatica

Dear Editor

The most important factor in determining treatment outcome is one that studies never address, ie which surgeon decides on the MRI changes likely to be relevant to the pain and proceeds to a treatment plan on that basis. My MRI showed “Significant degenerative change at the lower 4 levels resulting in significant central canal stenosis at L3/4 and compression of the left L5 nerve root at L4/5”. Surgeon no.1 opined that my pain, which had been present for 2 years, was not due to the central canal stenosis, and that steroid/local anaesthetic injection was the bst way forward. Being sceptical, I sought a second opinion from surgeon no.2 (name on application!) who had been recommended to me by my son on whom this surgeon had recently performed a micro.discectomy with excellent result. Surgeon no. 2, on the basis of the same scan and other clinical info. thought most of my pain was related to the spinal stenosis, and furthermore, injections would not be successful. He recommended minimally invasive surgery. The operation he performed 2 years ago – L3/4 bilateral decompression and discectomy, Left L4/5 microdiscectomy and lateral recess decompression – has given me total relief and my life back again.
In view of the lack of high quality evidence concerning the treatment of this spectrum of conditions, more than usual depends on the judgement and skill of the surgeon. If at all feasible, I would recommend patients with severe sciatica to always seek a second opinion on the proposed treatment plan.