Surgery is twice as effective as physical therapy and drugs for relieving pain and improving mobility in one of the most common back problems, researchers will report today.

The study, published in the New England Journal of Medicine, gives "us more confidence in recommending surgery to our patients," said Dr. Mark J. Spoonamore of the University of Southern California's Keck School of Medicine. The recommendation is "not just our gut feeling, but based on a strong scientific foundation."

The condition, called degenerative spondylolisthesis with spinal stenosis, occurs when one lumbar vertebra in the back slips forward relative to the one next to it, pinching the spinal cord and producing severe pain in the legs.

The condition affects as many as 600,000 Americans, although only about half of those seek medical treatment and perhaps only a quarter of them now undergo surgery, according to Dr. James W. Weinstein of the Dartmouth-Hitchcock Medical Center in Hanover, N.H., who led the study.

The bulk of the patients are older than 50, and women are six times as likely as men to suffer from it, with black women at greatest risk.

Conventional treatment involves physical therapy, steroids to reduce swelling and anti-inflammatory drugs. But only about 20 percent of patients get better and 20 percent stay the same without surgery, said Shamie, who was not involved in the study.

Surgery relieves pain by removal of bone and soft tissue in a procedure called a decompressive laminectomy. Because of the aging American population, back surgeries are one of the fastest-growing areas of medical care, with hospital costs alone totaling more than $21 billion per year, said Dr. Richard A. Deyo of the University of Washington.

The federally funded study included 601 patients at 13 medical centers in 11 states. Of those, 372 underwent surgery.

In a second study in the journal, a Dutch team led by Dr. Wilco C. Peul of the Leiden University Medical Center studied 283 patients with severe sciatica, which produces a burning pain in the sciatic nerve that runs down the outside of the leg.

Peul and his colleagues reported that sciatica patients undergoing surgery got much faster relief from the pain than those receiving only physical therapy and drugs, but that at the end of a year, 95 percent of patients in both groups were largely free of pain.

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