Disk patients all get better

Sciatica study finds no long-term difference between surgical, nonsurgical outcomes

November 22, 2006|By Ronald Kotulak | Ronald Kotulak,CHICAGO TRIBUNE

CHICAGO -- People suffering from a "slipped" spinal disk usually recover in two years with or without surgery, though surgical patients tend to see relief sooner, a major sciatica study has found.

Supported by the National Institutes of Health, the research was intended to help settle a 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 Association, were somewhat inconclusive, primarily because attempts to randomly assign patients into two groups broke down.

Of the 232 patients who were to have surgery, 40 percent changed their mind and opted for nonsurgical therapy, while 45 percent 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. David Flum of the University of Washington, who commented on the study in a JAMA editorial. "We can say that people who choose their intervention seemed to be choosing wisely because both groups got better."

Still, the study yielded several important findings, said its lead author, Dr. James 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 made of cartilage. When these disks rupture, usually through wear and tear, they can bulge inward, pressing on nerves in the spinal column and causing pain.

An estimated 12 million Americans have degenerative disk disease. Of the more than 1 million who undergo surgery to repair herniated disks each year, about 25 percent suffer from sciatica, pain in the hip and thigh. Surgery costs about $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 in different regions of 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 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.

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 doctors advise surgery out of concern that a sudden twisting movement might further damage a ruptured disk.

For patients whose sciatica causes intolerable pain or makes them unable to work or take care of a family, surgery will make them feel better quickly, said Dr. Eugene Carragee of Stanford University Medical Center, who wrote an accompanying JAMA editorial. And people who want to avoid surgery can do so knowing there is little risk of making the problem worse, he said.

Ronald Kotulak writes for the Chicago Tribune.

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