Is Surgery Best Way To Stop Back Pain?

(CBS)  Noah Hano has no trouble pulling his daughter in a sled now, but it would have been impossible a year ago. His back pain was excrutiating, CBS Evening News anchor Katie Couric reports.

"It got to the point where I was absolutely desperate. I would go in the yard, spend five minutes in the yard raking leaves and have to sit down or lay down," Noah says.

Susan Filskov can still remember the pain she felt after hurting her back shoveling snow five years ago.

"It is just miserable. It is just like a numbing pain that doesn't go away," Susan says.

Both Susan and Noah went to see a leading back surgeon, Dr. James Weinstein, of Dartmouth Hitchcock Medical Center. Both got the same diagnosis: herniated discs.

What causes the disc to herniate in the first place?

"The disc is made up of mostly water, and it get tears in it. If you get a tear in your tire, or your car, you would get a bulge," Dr. Weinstein explains.

The herniated disc, or bulge, can press on the nerves in the spine, causing pain. Some people can tolerate the pain with physical therapy, medications and steroid injections. But others choose surgery to remove that bulge that causes the pain.

In an effort to determine which approach is best, Dr. Weinstein's launched a major study of over 1,200 patients with back pain. He says he thinks that sometimes people are too quick with surgery. "I think that it be important for people to have good information," he adds.

Whether you have surgery often depends on where you live and what doctor you see. Earlier studies show that a patient is 20 times more likely to have surgery in Idaho Falls, Missoula and Mason City, as compared to Newark, Bangor and Terre Haute.

"It is so interesting that geography is destiny," Dr. Weinstein says. "It's not rational."

But no matter where you live, surgery is not necessarily the best or only option. In fact, Dr. Weinstein's findings, released today in the Journal of the American Medical Association, conclude that surgery is only slightly more effective in some cases than a non-surgical approach.

"We basically found that people who had very significant symptoms, that surgery, in fact, was better," Dr. Weinstein says. "However what was really interesting is that patients who decided not to have surgery who could wait also did very well."

Critics claim Weinstein's studies are flawed because some patients, like Susan, decided to have surgery, even though she had been in the group that wasn't going to be operated on. The operation was a success and she's been pain-free for four years. As for Noah, he did just as well by exercising and taking a wait and see approach.

The study was so controversial, Dr. Weinstein says, because "I guess some of my colleagues were worried that I might find the wrong thing. I am not sure."

He says his intent was not to put some orthopedic surgeons out of business.

"That was never the intent," Dr. Weinstein explains. "It was just to find the truth for patients."

[mrob67]

As with my previous post, that apparently has not posted, a back injury is permanent. It does not just go away. Anyone on here who tells you other wise is not being truthful. One disc herniation will almost inevitably lead to further spinal weakness and bulges along with other herniations. As you get older this in and of it's self becomes lesss of a problem but then arthritis of the spine sets in. In short with back pain all you can do is manage it. No cure. Why any respectable medical profession would say you can be cured is beyond me. I have had back injuries and severe ones. Your never the same and yes you do have to change your lifestyle. Some have to change jobs. Yes people react different to the various treatments but they all have reocurring pain and they all have that pain for life. So not to be a downer but if your back pain is more than muscular, i.e. disc herniation, disc bulge, spinal stenosis, or a number of other causes prepare to live with it for life. Your pain can be managed and provided you avoid certain back twisting activities and heavy weight, and heavy depends on you, you can manage. Some people can handle more weight than others but all people with permanent back injuries have a limit. A disc herniation, a bulge, spinal stenosis, and other similar illnesses are indeed permanent. Good Day, Rob.

Comment to savagebray:
I don't know if Intradiscal Electrothermal Therapy
or something like that is available for the neck
(Smith & Nephew Endoscopy) but I had it for lower back amd it made it better. I didn't want to deal with another surgery(L4,L5,S1). Cortizone shots can help a great deal. For what it's worth, try a pain management doctor first. Surgeons operate on people.
jmrogalski

[ampsanne]

My husband hurt his back several times, and in 1982 had his 4th & 5th discs removed. The neurosurgeon left it up to my husband if he wanted surgery or not. He could no longer stand the pain he was in, so had the surgery done. When the surgery was performed the doctor also found a congential disorder which he corrected. Then in 1997 he couldn't hardly move and in pain again, and a different neurosurgeon had to remove the 1st and & 2nd discs. He does not regret having the surgery done. And the amazing part is people can't believe he's ever had back surgery when they see him moving around the way he does, and he's 71 yrs. old. I give credit to the two great neurosurgeons he had.

[badgerman696]

I am a former Registered Nurse. I have worked in Nevada, Arizona, New Mexico, Texas, Colorado, Montana and Washington state. It is no mystery that different geographic regions involve different treatments. Doctors are creatures of habit. If there is a surgeon in the area whose patients seem to have fewer symptoms in their post-operative recovery, physicians are more likely to refer their patients.

26 years in nursing were spent in ER, OR and ICU. I have no statistics to go on regarding patients who visited a chiropractor and had an adjustment that resulted in injury or worsening of their symptoms. But I can tell you I have seen many patients as a result. Most chiropractors order X-rays before attempting an adjustment. My concern is their competence in reading the X-rays accurately.

I also have seen surgeons whose immediate reaction to cases is to cut. I have seen cases where surgery was performed because X-rays and tests did not reveal the root cause of symptoms. Many of those cases resulted in a patient recovering from the effects of surgery, to find they were no better off than before.

I would not consent to spinal surgery except as a last resort. And yes, I have spinal problems. I skied off a cliff in a blizzard in 1981. By the grace of God I was not paralyzed when I fractured 5 vertebra in my upper spine. Pain was a constant and unwanted companion thereafter. Nursing as a career worsened the pain until an on-the-job injury in 2003 ended my work.

[savagebray]

I have been told that I have a herniated disk and disk degeneration on a few disks in my neck and lumbar spine and been told that i have to havethat surgery. I am very ify about it and am worried about having it. Does anyone have any advice about alternative options instead of having neck surgery?
Bray

[stephnyman]

I am a pain management nurse. I also used to practice hospice and oncology. I have seen 3 incidents with 3 different chiropracters who did hurt a pt through ignorance. 2 of the pts had breast cancer and one had esophageal cancer. All 3 were in remission and then developed back pain. Each one went to a different chiropracter and instead of telling the pt to see the oncologist or get an xray they "aligned the spine". It turns out each pt had cancer spread to the spine--and died in less than 6mos. Back pain in a pt with a history of breast or esophageal cancer is a big red flag of spread to the spine. These were 3 different chiropracters in 3 different cities. And then there is the case of my father-in-law being told by his chiropracter that the reason he has back pain is because his disc is dehydrated--you would have to be severely dehydrated for the body to take fluid from the center of a disc--probably even dead before this happens. So chiropracters are not the be all and end all. And also, studies have shown weight might not be a factor in back pain, as evidenced by the people who are fit who have back pain. One more thing, many people have MRIs showing disc problems and they have no symptoms--so this alone is not a sole indicator of problems.

[lola12314a]

I have severe degenerative arthritis in my back and three disck to the left, lumbar 3,4,&5. Thankfully no nerve damage. I couldn't mix a cake for 1 min. without my back killing me. I swear by the cortizone shots I get. No surgery for me. I even have degenerative arthritis in my kness and ankles. The shots help so much. I'm in pain sometimes for a couple of days after the shots in my back, and fatiqued, but good for 5 weeks or so. I'm loosing weight and that's major. Medication is why I put weight on to begin with. I fell and that's what did it.

[Free Citizen]

The study was so controversial, Dr. Weinstein says, because "I guess some of my colleagues were worried that I might find the wrong thing. I am not sure."

He says his intent was not to put some orthopedic surgeons out of business.

"That was never the intent," Dr. Weinstein explains. "It was just to find the truth for patients."

Well, that pretty much sums up the ethics of surgeons doesn't it? Business at the expense of patients well being.

[radiob-2009]

I as a fellow back pain sufferer can honestly say that surgery improved my condition.A herniated disc and several degerating discs.I do have permanent left sciatic nerve damage which limits what I do physically.I can also tell you that after 3 years of back problems that they do not go away.A simple mistep off of a curve can put you right back into pain.To much bending,lifting or stretching can also inflame the area creating muscle cramps that do not end and the fiery pain.Once your back has been damaged there are things you can do,lose weight,eat healthy,quit smoking and exercise moderately.You have to know your limitations and do not exceed them.The ole rule no pain no gain does not work here.Pain will not always be a constant where it is debillitating,use anti iflamatories and try to stay away from prescribed medicine except when absolutely needed.There are far to many side effects that can shorten your life span in prescripton medicines.

[ionutcelgroaznic]

I had a accident 6 years ago.They found degenerative lumbar disk.I can say my first year was the worst, I barely stay on feet.But, know after 6 years I can say I'm quite fine, still minor problems.You should have surgery only if you have a clear indication for sugery,otherwise back pain can be treated with medication:the best was condroitin/glucosamine.I recomend that you avoid long walks more than 15 min,or the waiting position which are the most terrible for your back.Also heavy exercise is not good either.
So be pacient and realize that in time the pain will slowly go away.Also, bed stiffness is very improtant, buy double matress and always keep your back mobile and comfortable(no excesive heat).In other words try to forget about you pain.