Surgery found to speed relief from slipped disks

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Surgery found to speed relief from slipped disks

By Kotulak, Chicago Tribune

November 22, 2006

http://www.latimes.com/news/health/la-na-spine22nov22,1,2436353.story

CHICAGO — Back patients with sciatica caused by a slipped disk do

very well after two years whether they have surgery or undergo

nonsurgical treatment, a major study has found, though surgical

patients tend to gain relief sooner.

Supported by the National Institutes of Health, the research was

intended to help settle a long-standing controversy over the

effectiveness of spinal surgery to repair a slipped disk compared

with conservative therapy that includes exercises and anti-

inflammatory drugs.

But the results, reported in today's issue of the Journal of the

American Medical Assn., were somewhat inconclusive, primarily

because attempts to randomly assign patients into two groups broke

down. Of the 232 patients who were to have disk surgery, 40% changed

their mind and opted for nonsurgical therapy, while 45% of the 240

patients assigned to nonsurgical care decided to have surgery. The

study was conducted in 13 spine clinics in 11 states.

" We can't say which treatment is better, " said Dr. Flum of the

University of Washington School of Medicine, who commented on the

study in a journal editorial. " We can say that people who choose

their intervention seemed to be choosing wisely because both groups

got better.

" Of course it remains to be seen whether or not the people who chose

surgery, had they not chosen surgery, would they have done just as

well? That's really the question that everybody wants to know. "

Despite the crossover problem, the study yielded several important

findings, said the study's lead author, Dr. Weinstein of

Dartmouth Medical School.

" This study for the first time showed very significant improvement

in the patients who ended up with nonoperative treatment, " he

said. " On the other hand, if they had to engage in a surgical

option, they also did quite well and there weren't a lot of side

effects. We also learned that patients don't get a lot worse in

either treatment. "

The spine's vertebrae are separated and cushioned by disks that are

made of cartilage. When these disks rupture, usually through wear

and tear, they can bulge inward, pressing on nerves in the spinal

column, causing pain or partial weakness.

An estimated 12 million Americans suffer from degenerative disk

disease. Of the more than 1 million who undergo surgery to repair

herniated disks each year, about 25% suffer from sciatica, a burning

pain in the leg. Surgery costs approximately $10,000 and can be done

on an outpatient basis.

Trying to find an answer to the surgery-vs.-nonsurgery question for

herniated disks is important, Weinstein said, because the number of

spinal operations has been increasing, and the rate of these

surgeries can vary greatly around the country.

The study found that surgery quickly relieves disabling symptoms in

patients with sciatica when compared with nonsurgical care. Surgery

patients were often able to resume normal activities in a matter of

weeks, while those not being operated on usually took several months

or more to feel as good. But after two years, both groups appeared

to do equally well.

That means that sciatica " will eventually get better in most people,

but it can take a long, long time, " said Dr. Eugene Carragee of

Stanford University Medical Center, who wrote an accompanying

editorial. " By six weeks after surgery, those people are very close

to normal in pain, function and other parameters. "

The study also found that severely damaged disks do not appear to

pose a risk of paralysis or other catastrophic event if they are not

surgically corrected. Many surgeons advise surgery out of concern

that sudden twisting might further damage a ruptured disk.

For patients whose sciatica causes intolerable pain, surgery will

make them feel better quickly, Carragee said. And people who want to

avoid surgery can do so knowing there is little risk of making the

problem worse, he said.