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The Truth About Back Surgery

Surgery: Just Say "Not So Fast"

Here's the crux of the problem: We tend to think of back surgery as the Big Fix — the treatment that will, if other approaches aren't successful, work. Sometimes, in our desperation to get our lives back, it may seem like a good idea to jump over those less invasive procedures and go right to the big one. That's a good call in a few cases — where there's a risk of paralysis, for example — but those types of emergencies are rare. Otherwise, "surgery offers specific therapy for specific conditions," says Dr. Deyo. It should never be seen as "worth trying" for pain. Such hope on the part of patients — too often reinforced by surgeons — leads to operations that offer no relief.

Discectomies (removal of the herniated part of the disc) are the most common back surgery. But spinal fusions (operations that involve joining the surrounding vertebrae) have been rising — from just over 150,000 in 1993 to 350,754 in 2007. And so has the controversy over their use. Fusions that are done for certain very specific conditions, such as spondylolisthesis (in which one vertebra has slipped forward over the one below), can have success rates of more than 80 percent. But that's not the usual case. When the surgery's done for a "simple" degenerated disc, the results are far less happy. Fewer than half of fusions are appropriate, experts estimate, and fewer than half are successful, research confirms. And surgical fusions don't come cheap: The average cost is about $75,000, not to mention months of rehab and weeks lost from work.

The takeaway: If a doctor recommends an operation, get a second opinion — always. A good surgeon will understand that you need to be comfortable with any decision, and should provide your tests and records, says Alex Ghanayem, M.D., professor of orthopaedic surgery at Loyola University Medical Center in Maywood, IL. For a truly useful second look, and to find out if you would benefit from surgery, go outside your doctor's practice or center and consult with different types of specialists. Specifically:

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