When Is Back Surgery Helpful?

New Study Suggests Operations Can Benefit Some Back-Pain Sufferers, But Not All

(CBS)  Mary Cummings tried everything to relieve her back pain. Nothing worked, reports CBS News medical correspondent Dr. Jon LaPook.

"My pain radiated down my leg and it would appear spontaneously and I couldn't predict it," Cummings says. "It was very difficult."

Dr. James Weinstein of the Dartmouth Hitchcock Medical Center diagnosed Cummings with one of the most common back ailments for people older than 55: spinal stenosis, or narrowing that pinches nerves. One of Mary's vertebrae bones had also slipped forward over her spine.

Weinstein is leading an ongoing study of treatment for back pain. Results out today in the New England Journal of Medicine show patients with the condition did substantially better with surgery than patients without.

"Patients who underwent surgery got relief within six to 12 weeks, very rapid," Weinstein says.

Says Cummings: "I would have been someone incapacitated and disabled without this surgery."

But Weinstein's previous research on another common back problem — the herniated disc — showed surgery is not necessarily better than other therapy.

It's important information, because spending for back surgery on Medicare patients alone has increased 500 percent in the last decade.

"The question we have to ask is, are we actually making those patients better," Weinstein asks. "And is spending more money for all these spine operations making a difference in the health of our country? I'm not convinced it is."

Results from Weinstein's third and final study of the most common back ailments will be released later this year.

[servpro9180]

I suffered a major headon collision back in 1987. I was diagosed with a sick sinus node, had no low setting for a heart rate, a pacemaker was installed at age 28. To make a long story short, last year my spine @ C5, C6 and C7 callapsed causing my left side to go numb. After a cat scan they found what happened. Had my spine fused @ C5,C6 and C7 and my heart rate was normal. Turned out it was a pinched nerve the whole time! I feel 20 years younger, didn't realize that it wasn't normal to hurt all those years. I feel great!

[sharonh05]

I had cervical spine surgery in September 06 C4-C7, corepectomy, fusion the whole nine yards. In February 07 I had to go back and have revision sugery because I did not fuse. If I had it to do over again the answer would be NO. I am in constant pain with numbness. This was a great doctor at a great hospital..Vanderbilt in Nashville, Tn. I now go to a pain management clinic and am scheduled for an epidural on Tuesday. People do your research before you go under the knife.

[andielyn-2009]

I'm 31 years old and I have some severe back problems. I've been diagnosed as having herniated discs between L3 and S1. I also have tears in 2 of the discs and degenerative disc disease. I've been through physical therapy, traction, spinal injections and pain medicines...NONE of which have helped. The "spine specialist" I've been seeing for the past year for these problems has told me that I should just stay on pain medications for the rest of my life. I got a 2nd and 3rd opinions with neurosurgeons and both of them agreeded that I would benefit from surgery. Now I'm just currently awaiting approval from my insurance company.

[theblonde31]

Southern-gal, I have had those steroidal injection, since you asked for opinions, Mine did not work. I have had the decompressions, steroid, epidural injections and so far nothing as eased my pain. But everyone is different as is the pain of different kinds. I would say go for it, as it might help you. No one knows until you try it. I have also been through physical therapy, which only made my pain worse. So now the doctors want to do the spinal cord stimulator on me as a last resort, but of course disability still says I am to young to be disabled. So I await in such pain I hate to say what I have been thinking for some time now.........everyone I feel for you all. I also pray you all find relief somehow....Take care. If anyone would like a friend to talk to about back pain email me at [e-mail]

[irishone87]

Hello!
I just want to say that I had spine surgery performed by Dr. James Weinstein in 1989. I am doing great! I had a tumor on L4. Dr.Weinstein and his team rebuilt L4 and fused my spine L3-L5. I want to tell everyone that suffers with back pain, don't give up - sometimes it takes finding the right doctor! I was lucky enough to be refered to the best in the world (in my opinion). I will be thinking of all of you and saying a prayer that you too find relief.
Best Wishes!!

[motheroferin]

I have herniated L4 and L5 discs. I had constant back pain and pains shooting down my leg.Treatment included a variety of pain and muscle medications/injections, physical therapy and manipulation. Nothing was working and surgery seemed to be the only choice. My research showed that only about 20% of back surgery for discs was successful, and the recovery time could be long. Then I heard about the DRX-9000. After the second treatment, the pain in my leg was gone. I am on the last of 20 treatments today. I feel better. The only pain I have now is from the strength building exercises for the structural instability. This treatment has a national success rate of 86%. It works!

[luvny-2009]

Man this is all awful. I read that they were doing a surgery where they replaced disc's with I believe inflated ones and it worked great but of course insurance Co wouldn't pay for it. Also had 2 discs replaced in my neck. They did the bone fusion, worst thing I ever did. That was back in 2002 have pain all the time. Dr. that did it moved from NY to WV to work on kids! The Dr. that took over just wanted to keep me on pain pills, that was in Upstate NY.

[sbro777-2009]

Greetings all, First off I have not yet read the article reffered to here, but I have a herniated disc at L5-S1 and have been suffering for 6 months now. I have researched several possibilities. I have continued with non avassive procedures, traction, specific nerve root injections, etc. There is a procedure that is called plasma disc decompression, or nucleoplasty. This procedure has a 80% sucess rate for contained herniated discs vs. the 18% for surgical procedures. I do not know what surgical procedure they were referring to this morning, but there are several different types of back surgery. The majority of back surgeries for contained herniated discs has been proven to cause more damage than good ie. scare tissue, tissue and disc damage, fragments, etc. All of these lead to future problems.

[epilab]

Surgury works.......

Like many older adults (64) many suffer from lower back pain. However when it moved down both legs and butt...medical treatment was sought. After 3 month of physical therapy wilch did not help...an MRI showed spinal stenosis. No disk issues...but pinched nerves that will only get worse as I age. I was refered to a neurosurgeon. He indicated that epidural shots do not work in many people and are not a forever fix.

Following recommended surgury the leg pain was immidately gone. Lower back pain is going away with further therapy.

I can go for walks agin and normal life is being restored

[taylpatr]

Hey, if anyone with a good back wants to know what it feels like, the closest thing I can recommend is to lie on their back on a concrete floor. Then, roll on your side and insert a baseball between the floor and your spine. Roll on top of the ball. As you lay there, try to imagine not being able to take the ball out. See how long you last.

[lkmdallas]

I have had occasional pain in my back through the years, always remedied through rest and occasional muscle relaxers. I was totally blindside about a month ago with excreciation pain in my lower back, with some numbness in my upper thigh and extreme pain above my knee. The spine doctor pretty much had the attitude that with heniated discs in L3 and L4, surgery might be required. I explained I was one of those "don't" do surgery unless other things don't work. I've now had two spinal injections and am scheduled for a third. At first I wasn't sure they worked but a week after the second one I'm pretty much out of pain. I will next start some rehab. I read somewhere that no matter what you do, most back pain will resolve itself in about 3 months (I'm not mimimizing those people that have constant pain). I don't know what the future holds --I'm a realtor so needless to say spend lots of time at my desk and in my car. My heart goes out to those of you that are in constant pain. I'm also losing weight--10 lbs so far. I think we can't just sit there carrying all the extra pounds either with a bad back. I recommend the injections as a first step. I stopped the pain pills yesterday--talk about side effects--they made me crazy.

[twistedsiste]

I have scoliosis and had a Harrington Rod placed back in 1974. Those of us having this surgery then did not have the benefit of our surgeons knowing that not adjusting to the 3 dimensional plane of the spine only led to more problems later on in life. I have 17 fused vertebrae in my neck, thoracic and lumbar spine. I can barely walk due to pain and cannot literally straighten up, I am bent over due to my body compensating for the loss of lordosis in my lumbar spine. My hips and knees will be the next thing to go as they are taking on the extra stress that my spine cannot handle. My only alternative is chronic pain management. Surgery for correction which may or may not work is not offered in my state and my HMO wouldn't approve it anyway. When your back goes you are literally at life's mercy. Take care of your back and don't hesitate to ask questions about any procedure a physician recommends. It is your body. You have the right to know.

[davidberlind-2009]

Part I of II

Surgery works. I had a severely ruptured disk between L4 and L5. It was like a popped scallop. About 90 percent of the disk had ejected itself into the nerve sack. It was crushing the nerves going down my right leg and the pain was so unbearable, 24/7... even methadone had no effect. Quality of life was nil. The best position by the way (for those of you who haven't tried it) was draped over one of those big gym balls (stomach down). Finally, my doctor and my chiropractor concurred that I needed an epidural. The pain was excruciating. My foot was completely numb. They sent me to a neurologist who took one look at me and said he wasn't giving me an epidural... he was sending me to surgery. He told me that had I had "dropped foot" and had I not come to him when I did, I might have lost the use of my leg for the rest of my life (continued in my next comment .. Part II)

[theblonde31]

Donald Eastman, I feel exactly like you do. I cannot shower everyday either, I was in a car accident 6 years ago and have only gotten worse since. I have had the tests you have had, and nothing works so far. I am on 400 mg of morphine a day, which doesnt seem to work since I am still in severe pain. Disability fights me, says I can work because of my age, 42 now. I cannot sleep in a bed, I sleep in a computer chair. Otherwise I wake up crippled and cannot move if I sleep in a bed. I only get an hour or two of sleep a night. I quit driving because I do not think I am alert enough to be on the roads. Back pain is not in our heads!!! I had such an active life style before this. I worked 7 days a week at two very physically exhausting jobs. Now I choose between the dishes or laundry to do each day since I can no longer do both on the same day. It would be nice to be taken seriously for once. I lost everything because I cannot work. But disability says I can. I had to move away from my children to live with family just so that I would have a roof over my head. I will die before I ever have to be separated from my children again. Which scares me since the little lawsuit I got is running out while I await disability to deny me again. PS. I had two houses before this, and my life was as close to perfect as I could have ever asked for.

[sunni2u]

I have had the injections. Initially, they worked. Unfortunately, after several years, the injections stopped doing any good.

[danosr47]

I have had (3)Three Spinal Surgeries. The first was for a herniated disc,or so I was told.The second was to remove Disk Fragment(s) left in as a result of the first surgery.Some of the fragments were in the nerves of my spine the rest cause massive scar tissue build up. The third surgery (7.5 hrs.)was performed @ UVA Medical-Center and did give me some relief for about six (6) months before the pain,pressure & burning sensation returned. In my Pain Management Physican's opinion,I will be on pain killers for the rest of my Life.

[dsofield-2009]

I am a registered nurse who has suffered with back pain for almost 3 years now. I continue to work a 12 hour shift. It is extremely painful everyday. My co-workers ask me how I manage to work with such pain. I was diagnosed w/ herniated & buldging disks from L3 to S1. Worse on the left than on the right. By the end of the day it feels like a bear trap is on my buttocks, a pulled hamstring, and a numb foot all on the left side. I have had 6 epidural injections over the past 13 months (facet joint block & transforamen injections) and recently had some nerves cut in my back (radiofrequency neurotomy) in hopes of aleviating this pain. Nothing has worked for me. My pain has not changed one bit. I am however more aggravated. I did participate in a physical therapy program that had taught me some stretching exercises. This provides me w/ minimal relief along with using a lumbar pillow and a heating pad every night allows me to get out of bed in the morning to do it all over again the next day to work a 12 hour shift in the hospital. Pain medications that I have been on in the past have done nothing except make me drowsy & constipated. I don't believe Dr's take back pain serious. This is the worst pain I have ever had. I'm a frustrated 39 yrs old healthcare worker. Pain management has told me that there is nothing more they could do for me (I could have told them that six months ago).

[oradurand]

THE LORD HAS BLESSED WITH 58 YEARS. PRAISE GOD FOR HIS GRACE AND MERCY!!I'M A SINGLE PARENT WHO HAD TO WORK IN A TEXTILE FACTORY PICKING AND PULLING ON HEAVY BUNDLE DURING THIS TYPE OF WORK INJURIED MY BACK. THIS WAS BACK IN 95. I NEVER WANTED TO HAVE THE SURGERY. I ELECTED TO HAVE THE SPINAL INJECTION.I DID GET SOME RELIEF.BUT I WENT TO WORK DURING THE HEAVY LIFTING. I HAVE 3 BAD DISC IN L3-L-4&L5 PLUS A HERNIATED DISC.I'VE NEVER STOPPED WORKING .PAINS PILLS AND MUSCLES RELAXES HAVE HELP ME THEY CALLED IT PAIN MANAGEMENT!! BUT IVE BECOME ADDICTED!!! THE NERVE IN LEFT LEG

[june2010-2009]

I was pleased to read a publication that compared surgery to non-surgery. If you haven't read the publication in NEJM, than I highly recommend it. nejm.org However, I'm confused by Dr. Weinstein's comments about the cost of surgery not being worth it. That isn't anywhere in his paper. I'm confused by this comment because Dr. Weinstein's paper showed that patients who had surgery got better quicker, and had outcomes that were "superior" to those who had non-surgical treatment. He even points out that the patients who had non-surgical treatments only had a "moderate" improvement. In fact, they never reached the same success as the surgical patients. Does he realize how much non-surgical options cost? I do. I've had several opportunities to pay for it and it is expensive. I am all for learning about viable options, so that I don't have to waste any more money on ineffective, unproven treatments that only have a temporary effect, if at all. I checked out Dr. Weinstein's quote regarding the study on people with herniated discs. Did he forget that he told another publication: The as-treated analysis showed %u201Cstrong, statistically significant advantages for surgery at all follow-up times through two years.%u201D aaos.org/news/bulletin/marapr07/cover1.asp What patients really need is honesty from those who claim to be experts, whether that is a doctor or the media. If you%u2019re a patient, check out these links. Take the info to your doctor, and make a decision that is right for you.

[taylpatr]

I think that the recovery rate is better for heart surgery than back surgery.Of the four people I know who've gone under the knife, only one said they have had less pain since the operation. The lack of information in your story is reflective of the general prognosis of most doctors. They treat you like a junkie in emergency rooms. They make you sit and wait and then observe your behavior to see if you're just pill chasing or really hurting. They don't understand what it's like working 10 and 12 hr. days in construction, wearing 20 to 30 pounds of tools all day. If you're a doctor or E.R. staff and you're reading this, try and imagine what it was like to build your hospital. Or, better yet, go to a construction sight and watch how hard some people have to work to make this country work. Then, you can see why there are so many bad backs in this world.