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Study Questions (Do We) Need to Operate on (Spinal Column) Disk Injuries
New York Times ^ | 22 November 2006 | Gina Kolata

Posted on 11/22/2006 6:54:16 AM PST by shrinkermd

People with ruptured disks in their lower backs usually recover whether or not they have surgery, researchers are reporting today. The study, a large trial, found that surgery appeared to relieve pain more quickly but that most people recovered eventually and that there was no harm in waiting.

And that, surgeons said, is likely to change medical practice.

The study, published in The Journal of the American Medical Association, is the only large and well-designed trial to compare surgery for sciatica with waiting.

The study was controversial from the start, with many surgeons saying they knew that the operation worked and that it would be unethical for their patients to participate in such a study.

In the end, though, neither waiting nor surgery was a clear winner, and most patients could safely decide what to do based on personal preference and level of pain. Although many patients did not stay with their assigned treatment, most fared well with whatever treatment they had.

Patients who had surgery often reported immediate relief. But by three to six months, patients in both groups reported marked improvement.

After two years, about 70 percent of the patients in the two groups said they had a “major improvement” in their symptoms. No one who waited had serious consequences, and no one who had surgery had a disastrous result.

Many surgeons had long feared that waiting would cause severe harm, but those fears were proved unfounded

(Excerpt) Read more at ...

TOPICS: Culture/Society; Extended News; Unclassified
KEYWORDS: back; necessary; surgery
Author and NYT did a bang up job. One can only wish they did as well on politics and government.
1 posted on 11/22/2006 6:54:18 AM PST by shrinkermd
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To: shrinkermd
Many surgeons had long feared that waiting would cause severe harm, but those fears were proved unfounded

Am at present recovering from 2nd surgery for 2nd herniated disk.
Took the wait and see approach to the first one 2 years ago - the actual injury was 2 years, 8 months ago.
The sciatica did improve over time, but was still present - a dull ache. A routine physical exam noted severe atrophy in my right calf, loss of reflex in the right foot.
I hadn't noticed it over time, and don't wear shorts often, but standing in front of a mirror the difference in size between my right and left calfs was noticable at this point.
Went for a "nervation" test where they inject an electrical charge at one end of the nerve trunk and detect the time it takes to reach a receiver attached to the other end. A certain time is "normal", as was my left leg. The right was much slower and it was this lack of nervation that was causing the atrophy in the right leg.
Surgery ensued, and physical therapy in time, but that right leg has never come back.

Now, almost three years later I blew out another disc - it's congenital they tell me - and after trying oral steroids and Naproxyn (industrial strength Ibuprophen) we decided to cut again. It was the right leg sciatic nerve that was affected again, and I don't have any reserves.

So in my case, I do not follow the study... and I do not recommend ANYONE with sciatic pain to try and tough it out like I did the first time. Consult with a neurosurgeon and get a nervation test.
The quote above, I believe, is way wrong!

2 posted on 11/22/2006 7:10:12 AM PST by grobdriver (Let the embeds check the bodies!)
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To: shrinkermd
Great article - thanks for the post

I'm proof of their assertions. I had three damaged disks in my lower back. After different doctors telling me that I should consider surgery or a steroid epidural, a great neurologist told me to just do Physical Therapy. It hurt and took three months (with continuing exercises), but all is fine now (without surgery or pain treatments).
3 posted on 11/22/2006 7:12:27 AM PST by Tenyaka
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To: grobdriver

Good point - the key (even with the PT option) was to see a Neurologist and not just do it yourself. Fortunately, my sciatica hadn't gone down the leg.

4 posted on 11/22/2006 7:15:37 AM PST by Tenyaka
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To: grobdriver

I have had the sciatica problem on the right side for about 5 yrs now. I have 3 bad discs in lower back. Blew out C 6-7 a yr ago. I haven't found anything that works and still no surgery.
Was told that for the lower back surgery won't work, too many probs. Bad discs, arthritis, stenosis, and sacroiliitis. Neurosurgeon said he can fix the discs but that won't get rid of the pain.
It is genetic. It is called Degenerative Disc Disease.
I just decided I was not going to have surgery after surgery since I was told it would all be recurring.

5 posted on 11/22/2006 7:31:11 AM PST by sheana
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To: onedoug


6 posted on 11/22/2006 8:12:16 AM PST by windcliff
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To: grobdriver
My father blew out a disk about 15 years ago when I was in high school. Sounds like a similar situation, and he went to the doctor and a chiropractor. The MD basically told him to go ahead and try the chiro, as at the time it wouldn't hurt anything. Took a year, but he got back to near 100% use back.

Different situation, but sometimes surgery isn't needed.
7 posted on 11/22/2006 11:38:17 AM PST by redgolum ("God is dead" -- Nietzsche. "Nietzsche is dead" -- God.)
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To: sheana

My 35 year old daughter had disc surgery 2 years ago. Her pain was so excruciating that she begged the Dr. to operate. She had immediate relief after surgery but was back in the hospital within a few days with a re-rupture. Very rare. The 2nd surgery seems to have done the trick but the memory of the pain is always with her.
My son suffers from a herniated disc near the neck. He just underwent injections but whoever did the last one pricked him one too many times. He had a leakage of spinal fluid and was in and out of the hospital, with severe headaches, for 2 weeks. They didn't tie the injections to the headaches at first. He was in so much pain he swore he had a brain tumor. He, too, is all healed.

The irony is that my oldest son works for a company called Synthese which just got FDA approval for an artificial disc. He trains the doctor's in it's use.

8 posted on 11/22/2006 1:46:57 PM PST by surrey
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As an aside...exercise and maintaining a reasonable weight ratio will help prevent back problems. I know folks hurt their backs through accidents, and I am not suggesting (a la Tom Cruise and vitamins) that every accident is preventable.

However, an ounce of prevention is worth a pound of cure in some of these situations.

9 posted on 11/22/2006 1:54:07 PM PST by Vermont Lt (I am not from Vermont. I lived there for four years and that was enough.)
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To: shrinkermd

after carrying a 10 pound kiddo, i ruptured a disc in my lower
back. i tried, muscle relaxers, chiropractors and tons of pain
killers. when the pain was unbearable, pat took me to e.r. and
i was referred to a neurologist. within one week the pressure
on my spinal cord was so bad i had lost all feeling in my left
leg. i had laser surgery immediately. no stitches, no blood
transfusions and i was only home for a 4 week recovery period.
if i had not had the surgery i would not be walking now, i
would be disabled.

10 posted on 11/22/2006 2:08:42 PM PST by leda (Life is always what you make it!)
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To: windcliff
Investigate physical therapy first.
11 posted on 11/22/2006 7:10:09 PM PST by onedoug
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