Back Pain Often Ends Without Surgery
Study: Surgery Fastest Treatment for Back and Leg Pain, but Waiting Works, Too
Sciatica: Surgery vs. No Surgery continued...
As expected, early surgery meant quicker recovery. But Peul and colleagues were surprised by what happened in the conservative-treatment group.
"The most important result is that what we did not expect -- that in the conservative-treatment group, most of them also had a quick recovery," Peul tells WebMD. "It was slower than the early-surgery group. And 39% had longer-lasting leg pain and needed surgery. But at one year, the results for the two groups are nearly equal. Even at three and six months, the outcomes were not that much different."
Patients whose surgery was delayed got just as good results as those who had surgery right away.
"So for leg pain, if you cannot cope with the pain, there is a quite good reason to have surgery early," Peul says. "But if you can stand the leg pain and have enough medication and cortisone shots, you can postpone and even evade surgery. And patients have to be informed that whether surgery is done now or later, they will have the same outcomes."
Current recommendations are for patients to wait six weeks to see whether their sciatica gets better.
"I think we should wait at least two extra months to see if the patient is recovering. If not, or if the pain is worsening, surgery should be done early if the patient is asking for it," Peul says. "If the patient can sustain the pain, waiting is the best strategy. But if the patient very badly wants to do it, early surgery is a good choice."
Surgery does not always work. Peul says that one in 20 patients with severe sciatica has continued pain even after back surgery.
Spondylolisthesis: Surgery vs. No Surgery
Degenerative spondylolisthesis sounds bad -- and it can, indeed, be a very painful condition. It's a disease of aging, occurring six times more often in women than in men and affects black women in particular.
The condition occurs when one of the vertebrae in the lower spine slips forward across another. This may cause spinal stenosis -- a narrowing of the spinal canal that causes bone and soft tissue to press against a nerve. The result is pain in the buttocks or legs while walking or standing.