Delaying back surgery works for some

Studies of patients experiencing back and leg pain suggest that postponing an operation most likely does no harm, and some do just as well without surgery.

By Victoria Stagg Elliott, AMNews staff. June 25, 2007.

Patients with back and leg pain may do just as well with a treatment strategy involving pain-relieving medications, anti-inflammatories and physical therapy as they would with surgery, according to a pair of studies published in the May 31 New England Journal of Medicine. Also, delaying surgery does not appear to cause additional damage.

"Time is on their side," said Trish Palmer, MD, a family physician and assistant professor of sports medicine with Midwest Orthopaedics at Rush University Medical Center in Chicago. "The majority of people get better, but sometimes it takes longer."

For one study, researchers in the Netherlands randomized patients with severe sciatica to either undergo early surgery or have their treatment managed medically. Those in the latter arm could receive a surgical procedure if the sciatica did not resolve within six months, or sooner if they did not respond to medications or developed progressive neurologic defects. Those who had surgery sooner got better faster, but both groups had similar levels of recovery after one year.

The second study, by researchers participating in the Spine Patient Outcomes Research Trial funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, examined several hundred patients with lumbar degenerative spondylolisthesis. About half were in an observational cohort while the other half were randomized either to surgery or to medical management. All patients improved, but those who received surgery -- either because they were randomized to receive it or switched out of the medical therapy arm -- had more substantial improvement in pain and function when compared to those who received medical management alone.