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Thursday, December 14, 2006

Herniated Disk Improves With Either Surgical or Nonsurgical Treatment

"Patients with herniated disks had improved outcomes during 2 years whether treated surgically or nonsurgically, according to the results of a randomized trial with an accompanying observational cohort reported in the November 22/29 issue of JAMA.

"these findings suggest that in most cases there is no clear reason to advocate strongly for surgery apart from patient preference. For the patient with emotional, family, and economic resources to handle mild or moderate sciatica, surgery may have little to offer."

Gary Moller comments:
The terrible suffering and restriction on that severe back pain causes can probably never fully appreciated by others more fortunate.
With modern imaging techniques, detailed pictures can be obtained showing herniated discs and other mechanical abnormalities. Modern keyhole microsurgery makes the surgical solution increasingly attractive. But is it really that more effective than a decent physical therapy programme and the progress made by Mother Nature herself over time? This study, and many others over many years, show little extra benefit in most cases of going down the surgical track.

In most cases surgery must still be supported by months of progressive exercise to regain as close to full strength and mobility. This is more or less the same path as the non-surgical treatment approach anyway. Over the long term, there is little to separate the two paths in terms of final destination. I know that from experience of working in back rehabiliation for about 15 years.

If you are suffering back pain; unless you are losing sensation and function, then my advice is to take your time with deciding whether or not to take the surgical path to recovery.

Get the imaging done by MRI or ultrasound (DO NOT allow your internal organs to be irradiated by a cancer producing CT Scan). Discuss the results and the need for surgery with your specialist. Before making a final decision, if surgeryt is recommended, take the results of the imaging away with you and consult a range of back experts who have been in practice for at least 10 years - a physiotherapist, chiropractor, osteopath, various doctors and don't forget the Chinese therapist with the incomprehensible qualifications. If you undergo any treatment with any of them, do not allow any procedure to continue if you feel uncomfortable - tell the therapist to stop and discuss your concerns. Sometimes a regime as simple as a proper exercise programme, massage, stretching and a few key nutritional supplements can give gradual and lasting relief.

All surgery involves an element of risk. The outcome is never assured. The big worry nowadays is hospital based infections. Ask your Dr what the post-operation infection rate is in the hospital you are being referred to. If he/she does not know, you should insist on finding out. Hospitals prefer to keep this kind of information quiet for obvious reasons. Your Dr should know and so should you.

If you have back pain or a friend or relative who is suffering, a good present for the Xmas stocking is my book on Back Pain. You are always welcome to write in with your questions and concerns.

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