Back surgery or grin and bear it?

May 31 2007

A couple of new studies by researchers in the U.S. and the Netherlands have found that though surgery is effective for people with a slipped or misaligned disk, it often is not necessary if patients can summon up enough patience and wait awhile.

The researchers suggest that patients who have a number of back problems can benefit by not undergoing surgery.

These findings are important because around 1.5 million back surgeries are performed around the world to remove slipped discs to relieve pressure on a nerve which causes sciatica.

Sciatica is a condition in which a person's leg becomes numb or pain shoots down a leg; the condition is extremely painful and can affect a number of activities and the quality of life.

However the researchers say that 75% of cases will improve over time on their own without any medical intervention.

The first study led by Wilco Peul of the Leiden University Medical Center in the Netherlands involved 283 patients who had suffered with a back problem and approximately 95% of participants reported that their condition improved within a year whether they underwent surgery or not.

Richard Deyo of the University of Washington in Seattle writing in an accompanying editorial says for patients with persistent sciatica the choice between surgical and nonsurgical treatment equates and both options are reasonable, but concerns over surgical risks and the severity of symptoms will affect whether a sufferer is willing to wait for spontaneous healing to take place.

The second study by researchers at Dartmouth Medical School in New Hampshire, looked at 303 patients with a different back problem where degeneration in the spine bones causes one to slip too far forward.

The research team led by James Weinstein found that fusing the bones to treat this degenerative spondylolisthesis works better than nonsurgical treatment and the researchers found that almost half the 145 people assigned to nonsurgical care ultimately had the operation because their problem was so bad.

The 303 people in the study were offered either option and 130 initially decided against surgery; of those, 75 percent had stuck to that decision after a two year period.

As many as 300,000 spinal fusions are performed in the United States every year and Deyo says while it is clear that people with major motor problems require back surgery, the new studies suggest that "patients with herniated disks, degenerative spondylolisthesis, or spinal stenosis do not need surgery, but the appropriate surgical procedures may provide valuable pain relief."