Slipped Disc: Surgery Best for Pain?
Study Finds Time Often Heals Pain of Herniated Disc -- But Surgery Works Faster
Nov. 21, 2006 -- With time -- and medical help -- slipped disc pain gets
better. But disc surgery is faster and works better for bad pain, a large U.S.
The study shows that patients with a "slipped" or "ruptured" disc -- what
doctors call a herniated disc --won't get worse or become paralyzed if they
don't have surgery. Instead, they can expect to get better over time.
But when patients don't want to wait, surgery can mean a quick end to
excruciating pain, says study researcher William A. Abdu, MD, medical director
of the spine center at Dartmouth-Hitchcock Medical Center, in Lebanon, N.H.
"Patients with disc herniation can get better without an operation," Abdu
tells WebMD. "But those who have severe leg
pain -- and can't function well -- clearly will have improved outcomes if
they have the operation."
Slipped Disc = Herniated Disc = Pain
Rubber-like discs pad the bones of the spine. When one of these discs bulges
out into the spinal canal, it tends to push against the root of a nerve.
This causes intense back pain. Depending on which
nerve is affected, pain or tingling may run down into the buttocks, hip, and
With a combination of pain
treatment, proper exercise, and rest, the pain
often goes away or becomes only a minor nuisance.
Doctors usually consider surgery to remove the offending disc -- a
discectomy -- if the pain continues for six weeks.
But some patients who've had the surgery say it wasn't worth it. And
sometimes the pain of a herniated disc later gets better without surgery.
So is surgery really the best option?
That's a controversial question. There have been clinical trials in the
past, but various flaws have made them difficult to interpret.
So Abdu and colleagues took a new look at the issue. Their study focused on
problems with the lower back.
Waiting Works, Surgery Works Better
Dartmouth researcher James N. Weinstein, DO; Abdu; and their colleagues
compared disc surgery to treatment with education and counseling, non-steroidal
pain drugs, narcotic pain drugs, physical therapy, and/or
They gave 1,244 patients with herniated discs in the lower back a choice.
The patients could let a computer assign them to either surgery or nonsurgical
treatment for two years. Or they could pick one of the two options
Some 500 patients said they'd let the computer decide, although many of them
soon reneged and chose the treatment not picked by computer.
The result: After two years, nearly all the patients were doing better.
However, those who got surgery reported slightly better results than those
who got nonoperative care.
Another 743 patients said from the start that they'd make their own choice
between surgery and nonoperative care.
After two years, all of those patients were doing a lot better.
But those who chose surgery reported the best quality of life and the least
What all this means to Abdu is that patients have to decide. For some, the
right decision is surgery. For others, the right decision is avoiding
"Our study would suggest that, regardless of how you are treated for a
herniated disc, you will likely get better over time," he says.
But, "If your pain is intolerable, you will be much better after the
operation," he says. "You may still have a little pain or numbness -- but the
chances of this are much less with than without the operation."
The study appears in the Nov. 22/29 issue of The Journal of the American