Treatment for Disc Herniation: Does Surgery Make a Difference?Studies are ongoing trying to find the best treatment for disc herniation. The current standard of practice is to use nonoperative care for at least six weeks before considering surgery. Nonoperative care includes patient education, physical therapy, and antiinflammatory drugs.
One group involved in spine research is the Spine Patient Outcomes Research Trial (SPORT). Doctors and surgeons in 13 spine practices in 11 different states of the United States were part of this SPORT study.
In this study two groups of 250 patients were compared. All were 18 years old or older with a diagnosed disc herniation. Group 1 had surgery to remove the disc fragment. Group 2 had nonoperative care.
Follow-up was for two years. Patient results were measured based on pain, symptom severity, function, and patient-reported improvement. Overall, there was no difference in outcomes between the two groups. In general, the operative group had less sciatic pain after surgery. The surgery group also rated their progress as greater.
The authors point out that a large number of patients in each group switched to the other group. Some patients in the surgery group got better and no longer needed an operation. And some patients in the conservative care group got worse and needed surgery. This is called cross over.
The reasons for the high rate of cross over remain unknown. It may be the result of change in symptoms, which is common with disc herniation. The results of this comparison study point out the need to determine predictive factors. In other words, scientists hope to figure out which patients would do best having surgery and which would do better with an exercise program.
J. N. Weinstein, et al. Either Surgery of Nonoperative Treatment Led to Improvement in Intervertebral Disc Herniation. In Journal of Bone and Joint Surgery. May 2007. Vol. 89-A. No. 5. Pp. 1139.
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