Back Pain Often Ends Without Surgery
Study: Surgery Fastest Treatment for Back and Leg Pain, but Waiting Works, Too
May 30, 2007 -- For two specific kinds of back and leg pain, back surgery
offers the fastest relief -- but those who choose nonsurgical treatments get
Two separate studies reported in this week's New England Journal of
Medicine show that surgery is the fastest route to pain relief for two very
different conditions: severe sciatica and degenerative spondylolisthesis.
But the studies also show that these conditions do not worsen if surgery is
delayed -- and that nonsurgical treatments can relieve at least some of the
An editorial titled "Back Surgery: Who Needs It?" accompanies the
studies. Editorialist and back pain researcher Richard A. Deyo, MD, MPH, is
professor of medicine and director of the center for cost and outcomes research
at the University of Washington in Seattle.
"The people who truly need back surgery are those who need it to
preserve their ability to function," Deyo tells WebMD. "But short of
that, most back surgery is an elective procedure. It is not urgent. Patients
face real choices that are quite reasonable: either surgical or no
Sciatica: Surgery vs. No Surgery
Sciatica is pain or tingling that begins in the back or buttocks and runs
down the leg. The most common cause is a bulging disk in the spine. The bulge
presses against a nerve root, causing problems all along the nerves that branch
from that root.
Surgical treatment of sciatica relieves pressure on the nerve root by
removing a portion of the affected spinal disk. But sciatica often gets better
over time. Is surgery really the best choice? How long should a patient wait
before opting for surgery?
To answer these questions, neurosurgeon Wilco C. Peul, MD, head of the spine
intervention study group at Leiden University Medical Center in the
Netherlands, led a study of 283 patients with confirmed cases of severe
All of these patients' symptoms had lasted for six to 12 weeks. Even with
pain medication, they could barely walk and were not able to work around the
house or at their normal jobs.
Half the patients underwent early surgery, most within two weeks of study
entry. The other patients were assigned to "conservative treatment,"
which included pain management and physical therapy.
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."