Treating A Herniated Disk: Surgery Might Not Be Needed
If you're unlucky enough to have a herniated disk, which can cause shooting pains in the legs, your long-term prospect for a healthy recovery is good whether you choose surgery or less invasive treatment like physical therapy, according to a pair of studies published in the Journal of the American Medical Association this week. The studies followed more than 1,200 patients at 13 spine clinics across the country for two years. During the first six months, surgical patients experienced less pain and showed more improvement in physical function than patients in the other group. But by the two-year mark, the researchers found, the nonoperative group had improved considerably, even though surgery patients still maintained a slight edge. Still, "this study supports nonoperative treatment for patients who can manage their pain," says William Abdu, medical director of the Spine Center at Dartmouth Hitchcock Medical Center in Hanover, N.H., and one of the authors.
Surgery to repair herniated disks is the most common back surgery performed. A herniated or slipped disk generally occurs when the gelatinous material inside one of the fibrous disks that separate the spinal vertabrae ruptures outward and puts pressure on the spinal nerve. This sometimes causes the painful condition called sciatica. These studies, the largest to date on the treatment of herniated disks, lay to rest worries that not operating to remove the disk fragment might lead to paralysis or other serious problems like loss of bladder or bowel function, says Eugene Carragee, professor of othopedic surgery and director of the Orthopedic Spine Center at Stanford University School of Medicine, who authored an editorial accompanying the JAMA studies.
Depending on the severity of pain and a person's individual situation, he or she can feel comfortable opting for either surgery or more conservative treatment, says Carragee. Someone whose pain is only moderate, or who has the economic resources and family support to not work for several months will likely get better without surgery. But for someone in severe pain, or who has three toddlers at home or is a self-employed carpenter, surgery can offer the quickest relief, says Carragee, even though any surgery carries some risk from anesthesia or complications. "If you can't afford a long illness, the sooner you have the surgery the better you're going to do," he says.