Back Surgery Can Quickly Relieve Pain

But waiting won't hurt your chances of recovery, new research suggests

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HealthDay Reporter

WEDNESDAY, May 30, 2007 (HealthDay News) -- Back surgery can effectively relieve pain for certain back problems faster than nonsurgical means, a new study shows.

On the other hand, waiting to see if the pain goes away on its own won't affect the outcome of surgery if you decide to have an operation later on, a second study found.

Both of the studies, published in the May 31 New England Journal of Medicine, compared surgical treatment of back and leg pain (sciatica) caused by disc herniation or a condition called lumbar degenerative spondylolisthesis, which occurs when one vertebra in the back slips forward onto another.

"Not all pain -- whether back or sciatic -- can be appropriately managed with surgery, but if it is something that can be helped with surgery, like these two conditions, surgery can provide a more prompt relief of pain and return to function," said Dr. Jeffrey Spivak, director of the New York University Hospital for Joint Diseases Spine Center in New York City. He was not involved in the studies.

Another outside expert agreed. Dr. Dante Implicito, chief of spine surgery at Hackensack University Medical Center said that not all people with back pain need surgery. "Many patients are treated conservatively," he said.

An accompanying editorial in the same issue of the journal pointed out that 75 percent of people with sciatica pain see improvement in their symptoms within three months, even without surgery.

However, Implicito pointed out that conservative treatment or a wait-and-see approach isn't always practical. Some people are in so much pain, they can't function or may be in danger of losing their jobs if they can't get back to work, so they opt for surgery sooner rather than later even though they might eventually get better on their own. "These studies show that there can be tremendous improvement if patients are selected well for surgery," he said.

The first study, done in the Netherlands, included 283 people who had severe sciatica -- leg pain caused by a compressed nerve in the spine -- for at least six to 12 weeks prior to the start of the study. Half of the group was selected to undergo early surgery -- an average of 2.2 weeks into the study; while the other half was chosen to receive conservative treatment with the option of surgery at a later date. Thirty-nine percent of the conservative treatment group eventually decided to have surgery, and the average time from the start of the study to the surgery was 18.7 weeks.

The researchers found there wasn't much difference in disability between the two groups, but that those who had early surgery reported faster pain relief than the conservative treatment group.

"The time scheme of recovering was different, with a faster recovery after early surgery," said the study's lead author, Dr. Wilco Peul, a neurosurgeon at Leiden University Medical Center. "Fifty percent of patients [in the early surgery group] were recovered in 4 weeks after randomization, whereas prolonged conservative care would need 12 weeks before 50 percent were recovered."

"I would recommend to wait a little longer and delay the decision to perform surgery until three to six months after the start of leg pain. If, however, sciatica pain does not allow you to work or care for yourself or your family, early surgery remains a very good option and is safe," said Peul.

The second study included a little more than 600 people with degenerative spondylolisthesis, a condition more common in older people, and for reasons that aren't clear, black women. Half of the patients were randomly selected to undergo surgery, the majority of whom had spinal fusion, a procedure in which two vertebra are fused together.

The other half was to receive standard non-surgical care. However, many in the non-surgical group decided to have surgery, so the researchers had to adjust the study data, because the results were no longer randomized.

They found that after three months, and again at one year, people who had the surgical procedure had less pain and a greater improvement in function than those who didn't have surgery.

"These studies allow us to make better conclusions about the treatment options available for patients," said Spivak.

"Surgery is not the end answer for all pain problems, especially back pain. There have to be specific reasons to operate. In my practice, of all the surgical referrals I see, only about one in three end up getting surgery," Spivak said. But, for those with disc herniation or spondylolisthesis, these studies confirm that surgery can be an effective alternative, and that even if you wait to have surgery, "you wouldn't have lost anything in terms of your chances of doing well," he said.

Implicito emphasized that the most important thing someone with back pain can do is see a specialist with as much specific training in back problems as possible. "Back pain comes in a lot of different 'flavors', you need to be evaluated and diagnosed by a very well-trained person so you know what's relevant to your condition."

More information

The American Academy of Orthopaedic Surgeons has more information on preventing back pain.

SOURCES: Wilco Peul, M.D., neurosurgeon, and head of Spine-Intervention-Prognostic Study Group, Leiden University, the Netherlands; Jeffrey Spivak, M.D., director, New York University Hospital for Joint Diseases Spine Center, New York City; Dante Implicito, M.D., chief, spine surgery, Hackensack University Medical Center, N.J.; May 31, 2007, New England Journal of Medicine

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