Jeffrey R. Carlson, MD
Patients who are told they need spine surgery have many questions, and rightly so. They want to know about all of the risks, the expected downtime for recovery, any restrictions on movement and activity, and when they will start to see the benefits from having the surgery. Even with all the concerns about surgery, it’s generally assumed that the surgery will return the patient to a better quality of life than they are experiencing now.
One of the questions I’m most often asked during a discussion with patients is “Should I have back surgery?” This gets right to the heart of the matter. When patients finally ask me to consider performing surgery on their back or neck, they’ve tried all of the non-surgical options, including physical therapy, medications and injections. At this point, they must make a decision about whether or not the pain they have is preventing them from enjoying life and being productive. They must also weigh the prospect of pain relief after surgery.
A recent study from The Journal of Clinical Orthopaedics and related research reviewed the financial risks and benefits of surgical treatment for disc herniations. The researchers looked at the cost-effectiveness of surgery, including the impact of spinal disc pain on the patients’ workplace productivity and annual income. Compared to non-surgically treated patients, the average annual earnings for surgical patients increased by $1925. The surgical patients also missed three fewer work days per year than the non-surgically treated patients. Over a four year period, patients that had surgery earned $5000 more than patients that didn’t have surgery. According to Gunnar Anderson, MD’s research for “The Burden of Musculoskeletal Diseases in the United States”, workers in the United States spent more than 170,000 million days in bed in 2012 because of back pain, and during the same time period, almost 291 million workdays were lost. These lost workdays decrease productivity, income and sometimes even lead to the loss of a job.
The response to patient’s questions concerning whether or not to have surgery for a disc herniation will be best answered by the patient themselves. If the patient is being limited by a disc herniation, and the other non-surgical treatments aren’t able to manage the pain, then surgery is the best option. Given the loss of income and productivity that is related to a disc herniation, this decision should be made between the spine surgeon and the patient as soon as there’s a clear understanding of the patient’s desire to improve their quality of life.