Back Pain? Here's Relief
New research reveals what treats it best, and when
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 shed light on when back surgery might be the best option. The bottom line: It depends on what's causing the pain.
People with sciatica might want to wait and see, for example. In a study by Dutch researchers reported last week in the New England Journal of Medicine, people with the condition, in which a disk in the lower back presses on nerve roots and causes sharp pain in a leg or foot, showed equal improvement after one year whether they had surgery or relied on painkillers and exercise. On the other hand, those who had surgery to remove the piece of bulging disk early on said their leg pain got better faster. And about 40 percent of the patients who didn't get early surgery later went on to have an operation. So for those who don't get better on their own after a few weeks, surgery may be worth the pain and risk of complications.
Fusion. Surgery seems to be a good bet, too, for people with the tongue-numbing diagnosis of degenerative spondylolisthesis with spinal stenosis. When a vertebra slips out of alignment, and the bony canal in the spinal column is narrowed by arthritis, pain in the back or legs 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.
Surgery typically involves fusing two vertebrae together, as well as removing bone and soft tissue pressing on nerves. Spinal fusion is major surgery, requiring a bone graft from elsewhere in the body, and complications are a consideration. But "it looks like spinal fusion really makes a difference," says Richard Deyo, a professor of medicine at the University of Washington and Harborview Medical Center, who wrote a commentary on the spinal fusion study for the New England Journal. Still, he says, the study doesn't reveal "what happens in five or 10 years. This is not a permanent cure." The researchers plan to follow the study participants for 10 years to see if they need further surgery.
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 he and his colleagues published last November, people with 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.
This story appears in the June 11, 2007 print edition of U.S. News & World Report.