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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 it?

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 stenosis.

Patients who underwent surgery had better symptom relief and better daily function starting six weeks after the operation and persisting for at least two years.

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 condition."

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