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. study finds.
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 leg.
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 steroid injections.
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 themselves.