Should You Have Surgery for Back Pain?
Persistent back pain is one of the most common ailments, but surprisingly little has been known about how best to treat it. That leaves many patients worried that they will get worse if they don't have surgery—yet uncomfortably short of information to help them decide if surgery is worth the risks. Now, that murky picture is brightening: In the past six months, three studies have made it much clearer when back surgery is a good option. The bottom line: It all depends on what's wrong.
People with sciatica, in which a disk in the lower back presses on nerve roots and causes sharp pain in a leg or foot, might want to wait and see, for example. Most people with sciatica get better within three months, with or without surgery.
In the study, patients showed equal improvement after one year whether they had surgery or used such noninvasive approaches as painkillers and exercise. But those who had surgery to remove the piece of bulging disk early on, six to 12 weeks after the beginning of symptoms, said their leg pain got better faster, researchers at Leiden University in the Netherlands reported in the May 31 New England Journal of Medicine. And about 40 percent of the patients who didn't get early surgery later went on to have an operation. For those whose pain persists, a faster recovery may be worth the pain and risk of complications from surgery.
A second study found that surgery seems to be a good bet for people with degenerative spondylolisthesis with spinal stenosis. In this tongue-numbing diagnosis, a vertebra slips out of alignment and presses on the spinal cord, and the bony canal in the spinal column is narrowed by arthritis, pinching nerves. This causes pain in the back or legs that gradually becomes worse. The condition is common in older people and is the No. 2 cause of back surgery in the United States, after herniated disks. The surgery typically involves fusing two vertebrae together and removing bone and soft tissue pressing on nerves.
James Weinstein, an orthopedic surgeon at Dartmouth-Hitchcock Medical Center who led the study, says he was surprised that the patients who avoided surgery didn't do better. In a study published in the Journal of the American Medical Association last November, Weinstein and his colleagues found that people with pain due to a herniated disk did just as well after a year with or without surgery. "Age is an issue here," says Weinstein, noting that people with slipped disks are typically in their 40s and thus may recover faster on their own.
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