Two hundred and sixty-three patients with sciatica were randomized to undergo either rapid surgical intervention, or prolonged conservative treatment. The dual purpose of this publication was (1) to compare the extent of vertebral end-plate signal changes (VESC) between groups, and (2) to determine whether or not there is a correlation between VESC and disabling back pain. Results at 1 year indicated that surgical treatment was significantly associated with an increase in the extent of VESC in patients with sciatica compared to conservative treatment. Furthermore, the proportion of patients reporting both disabling back pain (both at baseline and at 1 year) and perceived recovery was similar regardless if VESC was present or not.