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Home > Shouldn’t I Try Everything Else Before I Have Back Surgery?

Shouldn’t I Try Everything Else Before I Have Back Surgery?

dr carlson

Jeffrey R. Carlson, MD, MBA, CPE, FAAOS

As an orthopaedic spine surgeon, I get this titular question multiple times a day seeing patients for clinical consults. They come to see me with nerves that are pinched either in the neck or lower back, having heard stories of people, maybe family members, who have had surgery in the past who never got “better”, like Aunt Mabel.  Because of these stories, they are scared to consider surgery and have convinced themselves that ANY surgical procedure for the spine is doomed to fail.

As exaggerations go, those statements seem far-fetched when viewed logically.   Most people that have spine surgery return to their normal lives and are too busy living to blog about it.  Those few patients that had surgery that did not meet their expectations will be found anywhere you search for information about spine surgery.   This typically holds true when it comes to any kind of consumer review.

Just as you do not have the same mobile phone as you did ten years ago, or even five years ago, technology and techniques have also improved in spine surgery.  The diagnostic procedures, MRI’s, anesthesia, pain management, and the surgery itself have all improved radically in the past ten years.

When I first came to Newport News 20+ years ago, the smallest of spine surgeries (discectomies) were being done by neurosurgeons who kept patients in the hospital for a couple of days. In my surgical training program, we did these procedures as outpatient, going home the same day, and now it is unusual for these patients to be kept in the hospital.  Many microdiscectomies are done in ambulatory surgery centers throughout the country.

When I talk to patients about treatment for their pinched nerve in their neck or lower back, I usually present three options: 1) Physical therapy and/or chiropractic manipulation to mobilize the nerve away from the protruding disc; 2) anti-inflammatory medications (pills or shots) to decrease the inflammation and pain; and 3) surgery to physically remove the mechanical compression of the disc on the nerve.  However, these three treatment options are not equal in their efficacy.  Therapy may help or may aggravate the nerve.   Medications and injections may help for a short period of time but will eventually wear off.  Surgery is only and quickest way to remove the disc material off the nerve, allowing it to heal, and enabling the patient to get back to their normal life.

A recent study evaluated the quality-of-life scores in patients that were treated with steroid injections or surgery for their painful lumbar disc herniation.  (World of Neurosurgery, 3/21/24). The researchers followed over 200 patients (men and women with an average age of 50 years old) and measured their Quality-of-Life scores for two years.  They found that those patients that had undergone discectomy were much happier, had much less pain and were more functional than those that had epidural steroid injections.  The results also showed surgical patients achieved those higher Quality-of-Life scores faster than the injection patients.

Certainly, it is reasonable to try to avoid surgery, if possible. But I have seen many patients look back, after delaying surgery for years, and wish they had their spine surgery sooner, because of the great outcomes they finally experienced. The relief of pain.  The restoration of function. The end of shots and medications.  They wish they had not wasted so much precious time honoring the memory of the spine surgery Aunt Mable had 50 years ago.

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