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Ruptured disk surgery as effective as doing nothing, study finds

Thursday, November 23, 2006 by: Jessica Fraser
Tags: sciatica, back pain, back surgery

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(NewsTarget) Patients suffering from ruptured disks in their lower backs tend to recover regardless of whether or not they opt to undergo back surgery, according to a new study appearing in today's issue of the Journal of the American Medical Association (JAMA).

The study -- led by Dr. James Weinstein, a professor of orthopedic surgery at Dartmouth -- spanned two years and included nearly 2,000 patients, most of whom were randomly assigned either back surgery to repair their ruptured disks or non-surgical treatment that included physical therapy, counseling and anti-inflammatory drugs to help treat associated pain.

Sciatica (ruptured disk) tends to run in families, and occurs when gel-like material inside a spinal disk protrudes through the outside of the disk lining, forming a bubble that compresses and inflames the root of the sciatic nerve.

Patients with sciatica generally experience intense, searing pain in the buttocks or leg, which can prevent them from walking or even sitting. Spine operations to relieve pressure in the disk and return the nerve to its normal position generally relieve pain quickly, but can be expensive and can require long waiting periods.

Roughly 300,000 Americans have sciatica surgery every year, and many believe that if they delay surgery, they risk permanent nerve damage or loss of bowel or bladder control. However, Weinstein's study found that patients who opted out of the surgery experienced the same benefits as those who chose to go under the knife.

Though patients in the study who chose surgery reported immediate pain relief, within three to six months both the waiting group and the surgery group reported marked improvements. After two years, roughly 70 percent of patients in the two groups reported major improvements, and no one in either group reported negative results.

Though the study wasn't able to determine which option is better for patients, research is under way to determine which option makes better financial sense. Also, the results could not be considered conclusive because about 40 percent of patients in the trial did not stick with their assigned treatment. Many who initially were assigned surgery ended up waiting, while some in the waiting group chose surgery to help with intense pain.

However, many surgeons believe the study will have a major impact on the way sciatica is treated, since the study determined waiting does not harm patients.


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