Surgery Works ... Even for Those Who Wait
Delaying an operation doesn't ruin recovery chances

(HealthDay News) -- If you're in no hurry to have back surgery, that's OK. Waiting, it turns out, probably won't affect the outcome of your surgery.

However, research also has found that back surgery can relieve pain faster than non-surgical treatments.

"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. Spivak wasn't involved in either study.

Results from both studies appeared in the New England Journal of Medicine .

As many as 85 percent of Americans experience back pain at some point in their lives, according to the American Association of Neurological Surgeons. About nine of 10 people with low-back pain will get better without surgery, though they may have recurrent episodes of back pain, the association reports.

"Back pain comes in a lot of different 'flavors,'" Dr. Dante Implicito, chief of spine surgery at Hackensack University Medical Center in New Jersey , told HealthDay . "You need to be evaluated and diagnosed by a very well-trained person so you know what's relevant to your condition."

Indications that surgery might be an appropriate option include pain that affects quality of life or limits a person's ability to participate in normal activities, progressive weakness or numbness, a loss of normal bowel or bladder function, or problems walking or standing, according to the surgeons' group.

One of the studies on back surgery included almost 300 people who'd had severe sciatica for at least six to 12 weeks. Sciatica is leg pain caused by a compressed nerve in the spine.

Half of the group was randomly selected for early surgery -- about two weeks after the start of the study -- and the others were given more conservative treatment. About 39 percent of those in the conservative-treatment group elected to have surgery eventually. The average time from the start of the study until surgery was about 19 weeks.

The researchers found no difference in the rates of disability, but the surgical group reported feeling better faster than the conservative-treatment group.

"The time scheme of recovering was different, with a faster recovery after early surgery," the study's lead author, Dr. Wilco Peul, a neurosurgeon at Leiden University Medical Center in the Netherlands , told HealthDay .

The other study included just over 600 people, and again, half of the group was assigned to early surgery while the other half received non-surgical care. But, many people in the non-surgical group later opted to have surgery.

Those who had the surgery reported less pain and greater improvements in function.

"Surgery is not the end answer for all pain problems, especially back pain," Spivak noted. "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."

But, he noted, the studies confirm that surgery can be an effective alternative. And, even if a person waits to have surgery, "you wouldn't have lost anything in terms of your chances of doing well," Spivak said.

On the Web

To learn more about common back surgeries, visit the North American Spine Society.

SOURCES: HealthDay News ; Wilco Peul, M.D., neurosurgeon and head, 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 of spine surgery, Hackensack University Medical Center, Hackensack, N.J.; May 31, 2007, New England Journal of Medicine ; American Association of Neurological Surgeons (www.neurosurgerytoday.org)
Author: Serena Gordon
Publication Date: May 31, 2008
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