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    Slipped Disc: Surgery Best for Pain?

    Study Finds Time Often Heals Pain of Herniated Disc -- But Surgery Works Faster
    By
    WebMD Health News
    Reviewed by Louise Chang, MD

    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.

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