If you suffer from a ruptured disk in your lower back your will recover whether you have surgery or not. However, your pain will be eased earlier if you have surgery. US researchers, in two new studies suggest there is no harm in waiting if you don't want to undergo surgery.
You can read about this in the Journal of the American Medical Association (JAMA).
There was some resistance to the trial from surgeons who felt it would be wrong to ask patients in pain to forfeit surgery just to see whether they would recover. However, the trial went ahead and the researchers concluded that both surgery and waiting are effective - neither one is better than the other. In other words, the patient can safely decide whether he/she wants to wait or undergo surgery. In the USA, surgery costs about $6,000.
One study involved 472 patients, with an average age of 42. They were all followed up for two years after being randomly assigned either surgery or non-invasive treatment. The non-invasive treatment included education, physiotherapy (physical therapy) and painkilling drugs. Surgery meant taking out part of the swollen disk (outpatient basis). The researchers found that both groups experienced similar improvements and relief of pain over the two year period. 4% of patients who had surgery needed another operation within 12 months.
(North America - Physical Therapy. UK/Ireland/Australasia - Physiotherapy)
The other study involved 743 patients. In this study the patients chose whether they wanted surgery or not. The researchers found that the surgery patients experienced earlier pain relief. After three months 82% of surgery patients felt better, compared to 48% of non-surgery patients. By the end of two years the difference between the two groups was insignificant.
In neither study did any patient develop Cauda Equina Syndrome - a disabling condition - a fear many doctors and patients have if they do not have surgery. These two studies show compelling evidence that the fear is perhaps unnecessary. In other words, a patient can safely decide whether or not to have surgery.
The researchers believe these two studies will have a major impact on how lower back pain is treated in future. In the USA about 300,000 patients undergo surgery to relieve back pain each year. Patients are often told that if they do not have the operation they risk serious complications - the two studies showed the complications do not happen.
Surgeons' fears of complications if patients did not have an operation were real - before these two studies there was no way of knowing.
Opinion of Editor of blog
From what I can gather after reading the studies, surgery is more likely to get rid of the pain earlier. If you can tolerate the pain and are willing to wait (not have surgery), you most likely will get better without complications.
Surgical vs Nonoperative Treatment for Lumbar Disk Herniation
1. "The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial"
James N. Weinstein, DO, MSc; Tor D. Tosteson, ScD; Jon D. Lurie, MD, MS; Anna N. A. Tosteson, ScD; Brett Hanscom, MS; Jonathan S. Skinner, PhD; William A. Abdu, MD, MS; Alan S. Hilibrand, MD; Scott D. Boden, MD; Richard A. Deyo, MD, MPH
JAMA. 2006;296:2441-2450.
Click here to see abstract online
2. "The Spine Patient Outcomes Research Trial (SPORT) Observational Cohort"
James N. Weinstein, DO, MSc; Jon D. Lurie, MD, MS; Tor D. Tosteson, ScD; Jonathan S. Skinner, PhD; Brett Hanscom, MS; Anna N. A. Tosteson, ScD; Harry Herkowitz, MD; Jeffrey Fischgrund, MD; Frank P. Cammisa, MD; Todd Albert, MD; Richard A. Deyo, MD, MPH
JAMA. 2006;296:2451-2459.
Click here to see abstract online
Another article that may be of interest:
"Surgical Treatment of Lumbar Disk Disorders"
Eugene Carragee, MD
JAMA. 2006;296:2485-2487
Click here to see editorial