About 10% of people experience symptoms from a herniated disk at some point in their lives. Symptoms usually occur when the protruding disk presses on one or more of the spinal nerves emerging from the spinal column. In some people, the disk presses on the spinal cord itself or on the cauda equina (the bundle of nerve roots at the bottom of the spinal cord). This causes pain not only in the back, but also in the part of the body served by the compressed and inflamed nerve. What should you do for relief?

If you have a herniated disk and experience back and leg pain from sciatica for more than six weeks, surgery may be the right treatment for you, according to a new study published in the journal SPINE (Volume 33, page 428).

In this study from the Spine Patient Outcomes Research Trial (SPORT), researchers randomly assigned 1,244 people with disk herniation and back pain for at least six weeks to undergo a diskectomy or usual nonoperative care including pain medication and exercise. Ultimately, 775 people had surgery within two years, while 416 received only conservative treatments such as nonsteroidal anti-inflammatory drugs, physical therapy, and education and counseling.

The findings are based on results from those 1,191 patients. Leg pain improved more than back pain in both groups. Both groups had improvements in back pain, but the surgical group fared significantly better: 28% of the surgical group had no pain three months after surgery, whereas only 12% of those who received conservative care had relief. At two years, 25.5%in the surgery group and 18% in the conservative-care group reported no pain.

If you have pain from sciatica that has been radiographically demonstrated to be caused by a herniated disk, then surgery is more likely than conservative care to provide you with partial or even complete pain relief.