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Old 06-01-2007, 02:29 PM
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Default Surgery can fix back problems, but time works too



• Study: Surgery works for slipped, misaligned disk, but often is not necessary
• 1.5 million disk operations done worldwide each year.
• 95 percent in study reported recovery after one year, with or without surgery

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BOSTON, Massachusetts (Reuters) -- 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 with 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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Old 06-01-2007, 06:44 PM
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I have herniated discs in the back and I also have the sciatic condition. My herniated disc became fused together due to doctors not believing I was in pain. Just remember DON"T be embarrassed like me to look like crap because of the amount of pain your in. The surgeon said all the $$ in the world couldn't allow himself to operate on me. He said if he did he'd have to operate every 5 years or so because each of my vertebrae in the spine would go. My sciatic is crushed 50% and can't be fixed being a nerve. So a few medications to help ease the pain a little and they say I'm Sorry. But I think of everyone thats worse off than I am even though I have more than those 2 things wrong. I say make sure you know your doctor. Most Important!!!
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