Risk-Reward
Imagine this: you take your car in for service, and the mechanic tells you it needs work that will cost upwards of five thousand dollars. Plus, your car will be out of service for weeks, and the work may cause other problems. Oh, and one more thing - after all that, your car won't run any better than it does right now.
If this happened to you, I'd bet you'd hightail it out of that mechanic's garage (and maybe call him some unprintable names, as well). But every year, a quarter of a million Americans say yes to a similar scenario - when they agree to have herniated disk surgery.
Herniated disks occur when cartilage bulges out between vertebrae in the lower back. The bulging cartilage then presses on nerves, causing excruciating pain called sciatica.
In the last several decades, doctors have attempted to resolve the problem through surgery. During the operation, surgeons make an incision in the lower back along the spine and remove the bulging disk. Many patients agree to the surgery, anticipating complete and permanent relief from their pain. With that reward in mind, I suppose the months of recovery and $6,000 cost seem reasonable.
There's just one problem: it usually doesn't work. Two new government studies confirm that patients who undergo herniated disk surgery are no better off after two years that patients who chose to simply wait it out and manage their pain.
Both studies directly compared pain, physical function and disability measures between herniated disk patients who had chosen surgery and those who had not. After two years, both groups showed great improvements in all measures. In fact, there was no significant difference between the two. While one of the studies showed that surgery patients saw results more quickly, the difference equalized over time.
It's true that herniated disk surgery has surprisingly few complications, and is typically performed on an out-patient basis. But it's not completely without risks: the protective lining of the spinal nerve roots (dura mater) can tear, and nerves can be injured. Plus, no surgery should be taken lightly - going under anesthesia can be risky, and these days, submitting to any surgery means exposing yourself to the possibility of life-threatening infection, as I told you about in a recent HouseCall.
There are exceptional cases that are appropriate for surgery, where compression of a nerve results in bladder or bowel incontinence or noticeable loss of sensation or strength in the legs, ankles or toes. In the vast majority of cases, however, there's just no reason to subject yourself to these risks, when you can get the same rewards with completely safe approaches. There are lots of simple things you can do at home to relieve sciatica pain. One source of good ideas is The Sciatica Relief Handbook, published by Agora Health Books. In these studies, patients found relief with painkillers, physical therapy, and rest.
And as these studies show, one of the best things for sciatica is time. No doctor can prescribe more of that - but it's safe, and as they say, it heals all wounds.
