Wednesday, July 19, 2006

Surgery Results Are No Sure Thing

If you're one of the millions of Americans contemplating surgery to remedy low-back pain, wait a minute and think about this...
A study released last June in Spine, an international journal for the study of the spine, found that most surgeons are "overly optimistic" when they're talking to patients about the benefits of back surgery -- nearly 40% of those surveyed had no measurable reduction in back pain post-surgery, even though their doctors had assured them of the results. How can that happen? It's the result of a complicated mix of doctors who are too quick to recommend surgery... patients who are desperate for quick relief and pushing for surgery... and surgeons who rarely hear feedback on the long-term results of back surgery because they are often out of the loop once the surgery is over. "Often the surgeon is not aware of what happens to his/her patients one year later and may simply assume that no news is good news, " says John-Paul Vader, MD, MPH, associate professor at the University of Lausanne Medical Centre in Switzerland and one of the study's co-authors. "What we need are high-quality clinical databases that systematically follow up on patients undergoing procedures (and those who forego the procedures) to help us acquire information about prognosis and outcomes."
Here are some things to try before you opt for the knife...

Wait it out. As excruciating as it sounds, many types of back pain -- including those associated with sciatica -- go away on their own within six to eight weeks.

Look for connections. According to Dr. Vader, the best candidates for surgery are those who have an acute case of sciatica (not back pain alone), with a protruding disc that can be viewed with radiological imaging, and a clear connection between the pain they're experiencing (including disappearance of a tendon reflex or massive loss of strength in the thigh or leg) and the nerve root affected by the protruding disc. If all of these factors aren't present, surgery likely won't be your best option.
Seek multiple opinions. Get advice from both surgical and nonsurgical specialists before you decide on the right course of action for your problem. For therapy advice, get a referral to a physiatrist, a physician who specializes in physical medicine and rehabilitation.
Get back to life. Don't baby your back for long -- it will only get weaker. "It is generally recognized now that, with the exception of perhaps a very short period of rest during the initial one to three days after an injury, the best results occur with those patients who have continued their normal daily activities," says Dr. Vader.
In the end, you may still decide that surgery is your best treatment option. But by studying all the alternatives available to you, you'll know what lies ahead should you choose surgery -- and you'll be more realistic about the possible outcomes.

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