Johns Hopkins Health Alert
Is Surgery Your Best Option for a Herniated Disk?
This Health Alert is intended for readers interested in learning about the prevention, diagnosis, and management of back pain.
About 10% of people experience symptoms from a herniated disk at some point in their lives. Symptoms usually occur when the protruding disk presses on one or more of the spinal nerves emerging from the spinal column. In some people, the disk presses on the spinal cord itself or on the cauda equina (the bundle of nerve roots at the bottom of the spinal cord). This causes pain not only in the back, but also in the part of the body served by the compressed and inflamed nerve. What should you do for relief?
If you have a herniated disk and experience back and leg pain from sciatica for more than six weeks, surgery may be the right treatment for you, according to a new study published in the journal SPINE (Volume 33, page 428).
In this study from the Spine Patient Outcomes Research Trial (SPORT), researchers randomly assigned 1,244 people with disk herniation and back pain for at least six weeks to undergo a diskectomy or usual nonoperative care including pain medication and exercise. Ultimately, 775 people had surgery within two years, while 416 received only conservative treatments such as nonsteroidal anti-inflammatory drugs, physical therapy, and education and counseling.
The findings are based on results from those 1,191 patients. Leg pain improved more than back pain in both groups. Both groups had improvements in back pain, but the surgical group fared significantly better: 28% of the surgical group had no pain three months after surgery, whereas only 12% of those who received conservative care had relief. At two years, 25.5%in the surgery group and 18% in the conservative-care group reported no pain.
If you have pain from sciatica that has been radiographically demonstrated to be caused by a herniated disk, then surgery is more likely than conservative care to provide you with partial or even complete pain relief.
Posted in Back Pain on August 21, 2009
Reviewed December 2011
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
Notify Me
Would you like us to inform you when we post new Back Pain Health Alerts?
Comments
Health Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the Johns Hopkins editors cannot be answered in this space.
The views expressed here do not constitute medical advice, and do not represent the position of Johns Hopkins Medicine or Remedy Health Media, LLC, which has no responsibility for any comments posted on this site.
YOur concluding statement ..."If you have pain from sciatica that has been radiographically demonstrated to be caused by a herniated disk, then surgery is more likely than conservative care to provide you with partial or even complete pain relief." though neutrally worded, clearly favors surgery but leaves out time and $ costs. HOw much time off of work, or time convalescing, is required for surgery, how much does surgery cost? I suspect the cost difference is large between surgery and conservative treatment. I think JH has a responsibility to choose words carefully. eg "surgery and conservative care both will improve pain, while surgery at a cost of about $_,___ more and ____ days more off of work, and with the risks that accompany surgery, may provide an edge over conservative treatment"
Posted by: SpinAlert | August 26, 2009 6:53 PM
I have had many herniated disks, lumbar and cervical. The majority of doctors I saw felt I should use consevative treatment because all of my herniations were caused by degenerative arthritis. All of my herniations healed on their own. Chiropractic care and physical therapy along with nonsteroidal anti-inflamatory drugs helped me. Some folks I have met who had herniations caused by injuries did well with surgery, but still had some poblems.I feel JH should give more detailed information on this very complicated issue. I did loose my job because conservative treatment took a long time, but now that I am old and have met many people who have undergone multiple surgeries who are far worse off than I am, I am glad I chose the conservative path.
Posted by: HERNIATIONS | December 5, 2010 2:12 AM
I HAVE LEARNED SO MUCH FROM YOUR SITE. I DO HAVE A QUESTION, I HAVE HAD OPEN HEART SURGERY FROM HAVING RHEUMATIC FEVER AS A CHILD AND 3 YEARS AGO HAD MY MAIN VALUE REPLACED WITH A PIGS VALVE AND THEY WERE APPLY TO REPAIR THE OTHER ONE. I HAD THIS DONE AT SACRET HEART AND THEY ARE SUPPER. I HAVE HAD MY BACK FUSED BACK TOGETHER FROM A FALL AND HAVE 6 HEARNEATED DISK AND LIVE IN A LOT OF PAIN. I ALSO HAVE A PACE MAKER BECAUSE MY HEART FIBULATES AND I AM ON WARAFIN. I WONDERED ABOUT A PAIN PUMP AND THE DANGERS IT COULD CAUSE ME. DO YOU THINK I SHOULD DO THIS I WOULD SENCERLY APPRECIATE YOUR OPPENION AND THINK OF IT AS ONLY THAT. I WT. IS 116 POUNDS AND 5 FT TALL 57 YEARS OLD AND I AM DISTSUSING IT WITH MY HEART DOCTORS, BUT LIKE TO BE WELL INFORMED. THANK YOU BRITNEY54
Posted by: Britney54 | May 8, 2011 12:46 AM
Post a Comment
Already a subscriber?
Login
New to Johns Hopkins Health Alerts?
What about other body systems impacted by the surgery? At age 63 I increasingly witness friends and family undergoing surgery and having lingering and in some cases life-altering effects from extended or multiple episodes of general anesthesia (they tell "funny stories" of doctors dismissing their concerns ... "but your knee works perfectly!") What responsibility does Hopkins Health Alerts have to acknowledge that among the elderly that there are predictable if low percentages of patients that have ongoing memory problems from having their brains "turned off"? Could it be that among the post-surgical patients some simply could no longer remember whether or not they experienced pain?
Posted by: HealthySkeptic | August 22, 2009 11:04 AM