The question of when back surgery should be considered is one that arises frequently with patients suffering with back or neck pain.

Although most physicians will tell you that surgery is always your last option, recent medical research suggests that early surgical intervention for some types of back conditions may be more beneficial.

Early Surgical Intervention Better

For patients with herniated lumbar disc, symptoms such as pain, function, general health, work status and patient satisfaction, were substantially worse if patients had experienced symptoms for over six months before treatment compared with patients whose symptoms appeared less than half a year before treatment reports a new study in the Journal of Bone and Joint Surgery (JBJS).

One of the most common and debilitating conditions of the spine, symptomatic lumbar disc herniation affects 1 to 2% of the population at some point in their lives, usually between the age of 30 and 40 years and is one of the most common and debilitating conditions of the spine. A lumbar disc herniation is a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) that allows part of, or the entire, soft central portion (nucleus pulposus) to be forced out from between two vertebrae. It causes back pain and can push on nerve roots causing pain, numbness and tingling as well as weakness in one or both legs.

Symptoms of lumbar disc herniation often improve within six to eight weeks. For this reason, treatment of the condition typically initially involves nonsurgical approaches, such as medications, education, counseling, and physical therapy. According to most guidelines, surgery should only be considered for patients who experience pain beyond a reasonable course of nonoperative therapy or who have progressive muscle weakness, loss of feeling or loss of bladder or bowel control from the nerve compression.

Over the last 30 years researchers performed numerous studies, which demonstrated the effectiveness of lumbar discectomy, a very common spinal surgical procedure in which the herniated disc material pressing on a nerve root or spinal canal is removed to treat lumbar disc herniation. Although the procedure is evidently effective, agreements in terms of preferable timing for surgery vary, with some studies suggesting “an appropriate amount of time” to others, who recommend “12 months after the onset of symptoms”.

One of the authors, orthopedic surgeon Jeffrey A. Rihn, M.D., commented:

“Patients often ask their physicians whether the duration of their symptoms will affect their potential for a full recovery, and the goal of our study was to address this question.”

Rhin and his team assessed 1,192 patients aged 18 years or older who suffered from various symptoms of lumbar disc herniation. All patients were enrolled in the Spine Patient Outcomes Research Trial (SPORT), which was conducted at 13 multidisciplinary spinal practices across 11 states.

Researchers assigned patients to undergo either operative treatment, such as a lumbar discectomy, or nonoperative treatment, including physical therapy, education, administration of a nonsteroidal anti-inflammatory drug, and/or counseling with home exercise instruction. Patients were required to complete questionnaires at the beginning of the study and at follow-up intervals, i.e. at six weeks, 3 and 6 months, and at 1, 2 and 4 years after treatment. The researchers used various strategies to assess the outcomes of both groups. When the researchers compared outcomes at follow-up intervals, of the 927 patients who had symptoms for six months or less with 265 patients whose symptoms had existed for longer than 6 months prior to enrolling in the study, they discovered that outcomes were substantially worse in those who suffered longer than six months at follow-up intervals. They also established operative therapy to be substantially more effective compared with nonoperative treatment; however, the relative increased benefit of surgery over nonoperative treatment was not dependent on the duration of symptoms.

Dr. Rhin explained:

“Patients who have had symptoms for longer than six months can find relief with either nonoperative treatment or surgery, but they may not reap as much benefit as those who have had symptoms for six months or less. Surgery still has significant benefit compared with nonsurgical treatment, even in patients who have had symptoms for longer than six months.”

He suggests further research to examine the effect of the duration of symptoms on treatment outcomes and concludes: “According to our study and generally speaking, patients who had symptoms for more than six months had less improvement in pain, function, general health, work status, and patient satisfaction.”

Source: Medical News Today

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