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Surgery can fix many back problems: studies
2007-05-30
Surgery works for people with a slipped or misaligned disk, but often is not necessary if patients can muster enough patience, according to two studies in the New England Journal of Medicine. Back problems are a difficult challenge for doctors in part because it is difficult to know when to operate. Consider sciatica, where a leg becomes numb or pain shoots down a leg because a nerve is pinched. In 75 percent of patients, the problem improves without surgery within three months. Nonetheless, 1.5 million disk operations are done worldwide each year. Typically, doctors remove part of the disk to take the pressure off the nerve. One new study, led by Wilco Peul of the Leiden University Medical Center in the Netherlands, looked at 283 patients who had suffered with the problem for at least six weeks. They found that 95 percent reported recovery after one year, whether or not they had surgery. However, 39 percent assigned to conservative care opted for surgery anyway, typically after about five months, and surgery relieved the symptoms twice as quickly. "Thus, for patients with persistent sciatica, there seems to be a reasonable choice between surgical and nonsurgical treatment, which may be influenced by aversion to surgical risks, the severity of symptoms, and willingness to wait for spontaneous healing," Richard Deyo of the University of Washington in Seattle said in a Journal editorial. The second study looked at a very different problem where degeneration in the spine bones causes one to slip too far forward. A team led by James Weinstein of Dartmouth Medical School in New Hampshire found that fusing the bones to treat this degenerative spondylolisthesis typically works better than nonsurgical treatment. Nearly half the 145 people assigned to nonsurgical care ended up having the operation anyway because their problem was so bad. "Surgery patients did a lot better," Weinstein said in a telephone interview. But when patients were allowed to choose for themselves, the outcome was a bit different. When 303 were offered either option, 130 initially decided against surgery and of those, 75 percent were able to stick with that decision after two years. This is the first sizable study to compare surgery to non-surgery and it allows patients to better understand their options, he said. "These are quality of life decisions." About 300,000 spinal fusions are performed in the United States every year. Deyo said 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."
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