Surgery or exercise for bad back debated in study

CHICAGO (Reuters) - Choosing back surgery over exercise to treat a herniated disc generally provides more relief, but the difference is minimal and fears related to skipping surgery are unfounded, researchers said on Tuesday.

A study involving more than 1,200 patients at 13 U.S. hospitals found either surgery to remove a bulging back disc or a course of physical therapy both helped ease the pain and discomfort two years after treatment.

A herniated disk, where the doughnut-shaped soft tissue cushioning the vertebra protrudes and impinges on nerves running along the spine, is a common problem that can recede with time and with the help of exercise, according to a report published in this week's issue of the Journal of the American Medical Association.

"Patients in both the surgery and nonoperative treatment groups improved substantially over the first two years," said lead author James Weinstein, one of the Dartmouth Medical School researchers who conducted the four-year study. The medical school is located in Hanover, New Hampshire.

Based on patients' responses, surgery tended to provide somewhat more relief than physical therapy, especially at first, for their sciatica and other pain. However the difference was not statistically significant, narrowed over time, and was likely to be exaggerated because worse-off patients opted for surgery and tended to believe that surgery must be more effective, the study showed.

"These findings suggest that in most cases there is no clear reason to advocate strongly for surgery apart from patient preference," wrote Dr. Eugene Carragee of Stanford University Medical Center in an accompanying editorial.

Widespread concerns that a bulging disc left untreated will result in worsening back problems, neurological deterioration, and numbness and even paralysis of the legs, buttocks or genitals, were shown to be unfounded, he added.

"The fear of many patients and surgeons that not removing a large disk herniation will likely have catastrophic neurologic consequences is simply not borne out," Carragee wrote.