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...
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.
Surgery involves laminectomy, an operation that removes part of the spinal
bone to relieve the pressure on the nerve. The procedure often includes fusing
the affected vertebrae with a bone graft.
Patients tend to be elderly, so surgery carries a risk. Is the risk worth
The answer is a qualified "yes," find James N. Weinstein, DO, of
Dartmouth Medical School in Lebanon, N.H., and colleagues. Weinstein and
colleagues report the two-year outcomes for more than 600 patients with at
least 12 weeks of symptoms from degenerative spondylolisthesis with spinal
Patients who underwent surgery had better symptom relief and better daily
function starting six weeks after the operation and persisting for at least two
But that doesn't mean surgery is for every patient.
"In this study, we see a greater benefit to surgical than nonsurgical
treatment," Weinstein tells WebMD. "But what has never been shown
before is the nonoperation patients do get better. So now there is a basis for
giving patients an informed choice about treatment options for this