What can surgery do for lumbar disc herniation

Harold Mandel's picture
Lower back and spine

If back pain is due to a lumbar disc herniation disability may be far more serious with more aggressive forms of treatment needed. Recent research shows that surgery is sometimes preferable to non-invasive treatment for better outcomes.

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Back pain can be a serious problem which can cause a great deal of pain and loss of productivity. If the cause of back pain is tension on the muscles a professional massage and rest are generally very helpful for recovery. However, if back pain is due to a lumbar disc herniation disability may be far more serious with more aggressive forms of treatment needed. Recent research shows that surgery is sometimes preferable to non-invasive treatment for better outcomes.

Researchers assessed the 8-year outcomes of surgery versus nonoperative care for the treatment of lumbar disc herniation, reports the journal Spine. Over the years although randomized trials demonstrated small short-term differences in favor of surgery, the long-term outcomes comparing surgical with nonoperative treatment have remained controversial.

For this study surgical candidates with imaging that confirmed lumbar intervertebral disc herniation were followed. Interventions used were standard open discectomy versus general nonoperative care. It was observed that carefully selected patients who underwent surgery for a lumbar disc herniation achieved more significant improvement than nonoperatively treated patients. But, there was little to no degradation of outcomes in either group from 4 to 8 years. Massage, exercise and stretching sometimes helps with lower back pain relief writes EmaxHealth reporter Deborah Mitchell.

A herniated disk most generally occurs in your lower back and is sometimes called a slipped or ruptured disk, writes the American Academy of Orthopaedic Surgeons. This is one of the most common causes of low back pain and of leg pain, or sciatica. Approximately 60 percent to 80 percent of people will experience low back pain at some time in their lives. A significant percentage of people will have low back and leg pain which is caused by a herniated disk. Even though a herniated disk is often very painful, many people feel much better with just a few weeks or months of conservative nonsurgical treatment.

When the jelly-like nucleus of a disk pushes against its outer ring due to constant wear and tear or a sudden injury a disk begins to herniate. The resulting pressure against the outer ring may result in lower back pain. When the disk is very worn or injured, the jelly-like center of the disc may actually squeeze all the way through. Although pain in the lower back may improve once the nucleus breaks, or herniates, through the outer ring, sciatic leg pain increases. This results from inflammation the spinal nerves because of the jelly-like material. This may also result in pressure on these sensitive spinal nerves, leading to pain, numbness, or weakness in one or both legs.

Often, a herniated disk is associated with the natural aging of your spine. In kids and young adults, there is a high water content in disk. As we get age, our disks begin to dry out and weaken. The disks than begin to shrink and the spaces between the vertebrae become narrower. This is a normal aging process which is called disk degeneration.

Aside from gradual wear and tear that comes with aging, there are other factors which can increase the likelihood of a herniated disk, including:

1: Gender. Men who are between the ages of 30 and 50 are more likely to have a herniated disk.

2: Improper lifting. If you use your back muscles to lift heavy objects, instead of your legs, this can cause a herniated disk. If you twisting while you lift this can also make your back vulnerable. If you lift with your legs, and not your back, this may protect your spine.

3: Weight. Being overweight puts added stress on the disks which are in your lower back.

4: Repetitive activities that strain your spine. There are many jobs which are physically demanding. Some of these jobs require constant lifting, pulling, bending, or twisting. The use of safe lifting and movement techniques can help protect your back.

5: Frequent driving. If you stay seated for long periods, coupled with the vibration from the car engine, this can put pressure on your spine and disks.

6: Sedentary lifestyle. Regular exercise is very important in preventing many medical conditions, including a herniated disk.

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7: Smoking. It is thought that smoking lessens oxygen supply to the disk, resulting in more rapid degeneration.

Low back pain is the initial symptom for most people suffering from a herniated disk. Sometimes the pain may last for a few days, and then improve. The pain is often followed by the eventual onset of leg pain, numbness, or weakness. This leg pain generally extends below the knee, and it often goes into the foot and ankle. The pain is described as moving from the back or buttock down the leg into the foot. In summary, symptoms may include one or all of the following:

1: Back pain

2: Leg and/or foot pain (sciatica)

3: Numbness or a tingling sensation in the leg and/or foot

4: Weakness in the leg and /or foot

5: Loss of bladder or bowel control (extremely rare) This could indicate a more serious problem called cauda equina syndrome. This condition results from the spinal nerve roots being compressed. Immediate medical attention is needed.

In patients with herniated discs in the lower spine, surgery leads to better long-term improvement in pain, functioning, and disability in comparison to nonsurgical treatment, concludes the eight year follow-up study in Spine. According to lead author Dr. Jon D. Lurie of Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine and colleagues, "Carefully selected patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operatively treated patients."

Although the results have added to the evidence for benefit from surgical treatment of herniated discs, it also showed that nonsurgical treatment can provide significant benefits for some patients. The study included an eight-year follow-up of data on 1,244 patients treated at 13 spine clinics across the United States. There were about 500 patients who were randomly assigned to surgery for a procedure called discectomy, or nonsurgical treatment. The patients were allowed to "cross over" to the other treatment. Standard measures of pain, physical functioning, and disability were than compared between these groups.

Patients assigned to surgery were found to generally have better outcomes. When considering a 100-point pain scale, pain scores were found to average about 11 points lower in the surgery group. There were similar differences in measures of physical functioning and disability. Surgery was also found to be associated with greater improvement in some additional outcomes, which included the sciatica symptoms, patient satisfaction, and self-rated improvement. However, again it must be highlighted that although average outcome scores were better with surgery, many patients still experienced significant improvement with nonsurgical treatment. In fact, after eight years, about one-third of patients who were clinically indicated for surgery have chosen not to have surgery.

Dr. James N. Weinstein a principal investigator, has said this is important and shows the vital role that shared decision making plays in the process. By going through shared decision-making including a review of objective information about the risks and benefits of their treatment options, patients were able to make an informed choice, which was in line with their own values. Dr. Weinstein noted that about a third of these patients have continued to be satisfied with their choice, and he feels this is in large part due to their being active participants in the initial decision-making process.

It has been my observation that lower back pain is in fact often a very debilitating condition. The pain and disability can be very costly. Many patients who are afraid of surgery often seek out alternative treatments for this problem, such as professional massage and chiropractic intervention, often with good results. Chiropractic spinal manipulation is often helpful for back pain, reports EmaxHealth reporter Kathleen Blanchard, RN.

However, if the problem persists these alternative interventions alone may not suffice to give the patient the necessary relief to move along with their lives. Dr. Weinstein's suggestion of shared decision-making regarding the best treatment for this problem is excellent and should make patients more comfortable discussing this problem with an orthopaedic surgeon.

I also recommend being very careful with your back. Stay in good shape with a daily walk of at least 30 minutes. Watch what you eat to help control your weight.Take breaks on long car trips. Do not lift heavy objects alone around the home. If your work requires you to lift heavy objects be careful to take your time and use your legs in the lifting process. And if the heavy work is too much for your back, try to find a new job where you do not have to do any heavy lifting.

Image courtesy of cooldesign/Freedigitalphotos.net

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