Back Surgery for disc herniations
A large study by Dvorak J. et al. reviewed the long-term results of patients that had received surgery for lumbar disc herniations. They reported that of the 575 patients studied, 70% still complained of back pain; 83% complained of constant heavy pain; 45% have a residual sciatica; 35% are still under some kind of treatment; 47% are receiving a disability pension and 17% required repeat surgeries.
The authors stated “Based upon the criteria given by Spine as related to justified or unjustified indication, there was no statistical difference in long-term results for surgery as compared to conservative care. The so-called justified indication for disc herniation neurosurgery does not necessarily imply a good long term result.”
The overuse of surgery has been perhaps the single most damaging medical intervention for back pain sufferers.Bigos and Battie reported, “Surgery seems helpful for at most 2% of patients with back problems, and its inappropriate use can have a great impact on increasing the chance of chronic back pain disability.”
In a Volvo award winning paper, Waddell reports,“Dramatic surgical success unfortunately only applies to approximately 1% of patients with low back disorders. Our failure involves the remaining 99% . . . for whom the problem has become progressively worse.”
In 1983, Weber reported that, even in properly selected patients, there is no difference in outcome between surgically and conservatively treated patients at two years.
In 1992, Bush et al stated that, “86% of patients with clinical sciatica and radiologic evidence of nerve root entrapment were treated successfully by aggressive conservative management.” They reported that, “the intervertebral disc pathomorphology that might seem best suited to surgical resection is in fact that which shows the most significant incidence of natural regression. . .these results confirm that if the pain can be controlled, nature can be allowed to run its course with the partial or complete resolution of the mechanical factor . . .lumbar herniated nucleus pulposus can be treated non-operatively with a high degree of success.”
Bush et al also stated that “Surgery clearly has its place in the treatment of lumbar spine disorders. Conservative care practitioners must be able to select the patients who satisfy the criteria for surgical intervention. These criteria are more strict than previously believed.”