Can't Stand Back Pain? Surgery May Be the Answer

May 31, 2007 — -- For the millions of Americans with slipped discs and lower back pain, 30-year-old Andrew Neitzke's story strikes a familiar nerve.

"My left leg hurt enough that I couldn't walk for more than a few minutes — sometimes even 30 seconds was difficult — and I also couldn't sit for long," he said. "The pain was even waking me during the night, and there were nights when I couldn't sleep at all."

Months of medications, physical therapy and steroid injections offered little relief. He was in a bind — should he wait it out, or go under the knife?

Two studies in the current issue of the New England Journal of Medicine may help patients like Neitzke with their decision. The studies compare surgical versus nonsurgical treatment for two common lower spine conditions that cause pain.

James Weinstein, of Dartmouth Medical School, and his colleagues studied more than 600 patients from 11 states with degenerative spondylolisthesis — a type of lower back pain caused by slippage of the bones of the spine. This slippage can cause parts of the backbone to press on nerves, potentially causing a great deal of pain.

What researchers found was that the patients who ended up in an operating room — about 60 percent of those in the study — experienced less pain and better physical function after two years compared with those who did not have surgery.

Those who opted for nonsurgical treatments — including pain medication, physical therapy, steroid injections and chiropractic treatment — also improved, but not to the same extent.

"There are two major treatment options: operative and nonoperative," Weinstein said. "This trial shows there is clearly a greater benefit of surgical versus nonsurgical treatment, but nonsurgical treatment is also an option.

"There were still many patients who never got surgery ... and it was good enough for them."

In a separate trial, Dr. Wilco Peul and his colleagues studied nearly 300 Dutch patients with sciatica — a radiating pain in the leg from compression of nerves in the lower back, often caused by a slipped disc.