QUALITY: The herniated disk story

QUALITY: The herniated disk story

20
SHARE

Medpundit has a pretty good explanation of the recent study about herniated disk surgery. Basically it works, but if you wait two years, then the results are about the same as non-surgical treatment—roughly 70% of people get better, and there doesn’t appear to be any long-term harm from delaying surgery. As I have someone very close to me with a current case of extreme back and leg pain from a herniated disk, I’m very interested in the study, and actually more inclined to suggest surgery (especially arthroscopic) sooner rather than later. But in this case the patient, doctor and other advisors are more in favor of waiting it out.

So on a global level it’s more cost-effective not to do the surgery. But on an individual level it probably lessens the pain—and the pain is close to unbearable, and if you have to put up with it for several months, then surgery is probably an option the patient will want.

Note that this is only the case for herniated disks and not lots of the other back issues for which surgery is probably ineffective–but still done at a very high rate.

The good news is that ten years after AHCPR (the forerunner to AHRQ) was decimated by daring to discuss back surgery, we’re getting studies out about this type of issue. Even, as Medpundit points out, it’s not a great study and it’s very, very hard to do studies about this type of intractable medical problem.

CODA: One slightly disquieting anecdote. I asked a local back specialist (non-surgeon) what the best way of doing surgery was (open or athroscopic). He said that the choice depended mostly on the training of the surgeon! Er…shouldn’t the surgeon be trained in the most advanced manner? (I expect those who know to chime in here)

Leave a Reply

20 Comments on "QUALITY: The herniated disk story"


Guest

But businesses that capitalize on this conception will be well in advance of
the competitor who doesn’t capitalize on these Modern slews.

While it is a very good Twitter app, I feel at it lacks the vibrant and lively interface features of the
top Twitter apps for Black – Berry listed below. In using social
media, the tradeoff for protest leaders is that they must expose themselves to disseminate
their message to the masses (although there are ways to mask IP addresses and avoid government monitoring, such as by using proxy servers).

Guest

Your means of describing all in this paragraph is genuinely good, all be capable
of easily be aware of it, Thanks a lot.

Also visit my webpage: San Francisco mover service

Guest
Apr 24, 2013

Hi there! Do you know if they make any plugins to help with SEO?

I’m trying to get my blog to rank for some targeted keywords but I’m not seeing very good
success. If you know of any please share. Thank you!

my page … Amy

Guest

An inversion table would probably help with back pain – at least it has helped for me!

Guest
Joe
Mar 11, 2013

“Chiropractic therapy” is voodoo cult nonsense.

Guest
Nov 19, 2012

I have been treating patients with disc problems for the last 18 years and have had a lot of success in helping most of them resolve their problems non-surgically. Of course, there is a small percentage that fail conservative care and end up going through with surgery. Interestingly, I have treated a large number of patients who failed microdiscectomy within 6 months of the procedure who had fantastic results with spinal decompression and chiropractic care.

Guest
Oct 15, 2012

The body has a powerful ability to heal itself.

The body’s structure (mainly the spine) and its function are closely related, and this relationship affects health.

Chiropractic therapy is given with the goal of normalizing the relationship between structure and function and helping the body as it heals.

Guest

I am definitely not a doctor, but I HAVE thrown my back out a few times.
I found out about the following exercises, which have really helped me out quite a bit (do a youtube search for more thorough descriptions):
1. MacKenzie Pressups – 10 reps
2. Hip extensions – 8 reps x 5 sec hold
3. Birddog – 4 reps x 10 sec hold
4. Side bridges – 5 reps x 10 sec hold on each side
See if these work for you.
-Ian

Guest

I agree with the post about judging on a case by case basis. Many will resolve with conservative care 70-90% depending on the source. However prior to surgery for disc herniation I have most of my patients evaluated for epidural steroid injection. This at times can be a less invasive way of getting pain and symptomatic relief.

Guest
Sep 29, 2008

For hernaited disc surgery it is important to consider the individual case. Where is the pain located, what is the level of function of the patient, are they improving with natural history or with conservative treatment. As with any surgery, there are always risks. The patient should ask the surgeon the benefits and the risks before deciding on an invasive option for herniated disc surgery.
Sandra McFaul

Guest
Joanna
Jul 9, 2007

My Mom who is now 55 had a slipped disc operated on 11 years ago. Not long after her surgery she started to lose her balance. After MANY tests and a couple of years she was diagnosed with ataxia (sporadic). Her cerebellum has been shrinking every since and she has lost ALL coordination, speech, swallowing, and more! Today she lies in a hospice and is in her last days (55 years old). I am sure and always have been that the surgery she had for the slipped disc was the cause of all this. She was very active and healthy before all of this and we have no family history of anything like this. If anyone has an opinion on this I would love to hear it please (joannauga@comcast.net)

Guest
CB
Jun 16, 2007

Hey, I got a microdiscectomy if anyone reads this. It’s working well for me so far.
-CB

Guest
CB
May 8, 2007

This thread is old, but I’m curious to know more about the efficacy of microdiscectomy and possible deleterious side-effects.
I have Ehlers-Danlos syndrome and 2 extruded disks in my back. One extrusion is causing partial foot drop and the symptoms have been unchanged for a month.
My doctor says that without intervention and without spontaneous improvement, the neurological impairment will become permanent, but I hesitate to operate, given the fact that my spine is already structurally unstable due to the EDS.
How long can I go with the foot drop without it becoming permanent?
Will this surgery cause instability in my spine and make future problems worse?
What about stents? Is it possible to put a stent around the nerve to protect it from the extruded disk material? Will this help with stability?
I appreciate any response. My email is cpondwork at yahoo.
-CB

Guest
pgbMD
Nov 30, 2006

I agree that the incidence of such devastating injuries such as bowel and bladder incontinence after discectomy are exceedingly rare, but nevertheless they are still present. I also agree that the results are surgeon dependent.

Guest
C. DuBois
Nov 28, 2006

Matthew, as a recently trained spinal surgeon (finished my fellowship in 2004) hopefully I can help clarify things. Arthroscopic(within joints) and endoscopic procedures are both performed using a monitor instead of direct visualization (as in an open surgery). At this date, true endoscopic surgery for herniated discs (via a percutaneous approach) is not as commonly performed. The “open” procedure your friend is speaking about is likley a “mini-open” procedure done through a 2-3 inch incision. The less invasive option (and becoming more common as surgeons are trained in the technique), is a minimally invasive technique through a 18mm-22mm incision via a tubular retractor, under a microscope (in effect, direct visualization). Both techniques (mini-open and minimally invasive) share almost identical outcomes.
The interesting thing about the study from last week, is that none of the information is anything we didn’t already know. There have been other papers in the literature that have demonstrated equal efficacy b/tw surgery and conservative care (in the long term). Most spine surgeons will also agree that unless the patient has an obvious neurologic deficit, it would be rare to have any permanent neurologic sequale (also well supported in previous studies).
In my practice, I will always explain that, in all liklihood, things will improve regardless of the patient’s decision to operate. What surgery does do is speed the rate at which return to function occurs.
The irony of all of this is that of all the spinal procedures with questionable benefit, the current discussion is about a procedure with sucess rates in the high 90s%.
In response to pgbMD, complications such as permanent neurologic deficit or bowel or bladder incontinence are exceedingly rare after discectomy. The incidence of nerve root injury (permanent or temporary) has been reported as 0.2%, and infection at 0.5%-1.0%. This is a safe procedure (in the right hands) and in my practice is performed as an out-patient.