When it comes to life's great equalizers, back problems are right up there with death and taxes. Roughly eight out of ten Americans will be walloped by back pain at some point in their lives. Those with muscle aches and strains usually rebound quickly. But others are held hostage by a herniated disk: Like a bubble on a tire, the disk's soft innards bulge through a weak spot in its outer casing, pressing up against neighboring nerves. These people suffer for weeks as nerve pain radiates from the back down to the legs and feet. One of the most popular solutions has been a diskectomy, surgery that involves pinching off the pooch. In 2005, on the advice of surgeons, more than a quarter of a million Americans had the procedure.
But in the fall of 2006, the Journal of the American Medical Association published two landmark studies calling into question the wide use of diskectomies. For the two trials, scientists recruited more than 1,000 men and women with nerve pain caused by herniated disks. In the studies, people chose—or were randomly assigned to receive—either surgery or a combination of nonsurgical treatments, including physical therapy, chiropractic, and painkillers. After two years, the researchers found that most people felt better regardless of whether or not they'd had a diskectomy.
Eugene Carragee, MD, director of the Orthopaedic Spine Center at Stanford University Medical Center, explains that, given time, the body often reabsorbs most of the disk's bulging tissue, and nerves grow accustomed to any remaining pressure. “The research shows that if you hang in there, the nerve pain will often get better.”
Forgoing surgery means patients can avoid its risks, such as excessive bleeding, nerve damage, and infection. But not everyone can wait. People with the most intense suffering were more likely to opt for surgery, and many reported feeling better as little as six weeks later. Meanwhile, for their peers who sidestepped the OR, back pain receded gradually over the following 12 to 24 months, though most reported significantly less pain after two months. Surgery makes sense for those who don't have time to heal—people with physically demanding jobs, for example, or small children, says James Weinstein, DO, chair of the department of orthopedic surgery at Dartmouth-Hitchcock Medical Center and coauthor on both studies. “This is a decision you'll have to make with your doctor,” says Weinstein. “But nobody should feel that surgery is the only option.”