To Cut Or Not To Cut

For patients with mild sciatica, whose jobs don’t involve twisting and bending, letting nature take its course may work best. For a carpenter who is unable to work as a result of back pain, though, surgery and immediate relief may be preferable. “If you’re out of work for six to nine months, you’ll lose all your business,” says Dr. Eugene Carragee, professor of orthopedic surgery at Stanford Medical School and author of an editorial accompanying the studies. Health insurance and disability coverage are also factors.

“One person may have great disability insurance and can stand to be out of work that long,” says Carragee. “Even though the data shows that after six, nine, 12 months, the outcomes of people who had surgery vs. people who did not becomes very similar, and by two years, they’re even more similar, that’s small comfort if in the interim you spent your children’s college fund.”

Internet marketing consultant David Haas, 45, says he will never forget the “knifing, searing pain” in his calf, triggered by a herniated disk in his spine. He had moved a couch, which caused a piece of disk about the size of a chick pea to break off and press against a nerve. Occasionally, the pain was so bad he had to have his wife drive him the 250 steps from his home to his office. He tried getting acupuncture, visiting a chiropractor, walking in a pool and reading Dr. John Sarno’s “Healing Back Pain: The Mind-Body Connection.” Nothing worked. A friend introduced him to Dr. Alexander Vaccaro, professor of orthopedics and neurosurgery at Thomas Jefferson University in Philadelphia. Vaccaro took out the offending piece of disk. And Haas felt instant relief. “I almost liken it to the thorn in the tiger’s paw,” he says. “When they took that thorn out, I was a new person.”

Haas’s experience with the couch is not unusual. Typically herniated disks are “random events,” says Carragee. “Usually it is something completely benign—leaning over to pick up a piece of tissue off the ground.” That event is more of a trigger than a cause. “Whatever the final event is, that is the end of a long, degenerative process. It isn’t that you went from a good disk to a herniation,” he says. The disk cracks, and a piece that’s less than a tenth of the size of it migrates out of position and leans on the nerves. The body eventually absorbs that chick pea-sized piece, and the patient usually feels better from the simple “passage of time,” says Carragee.

To Sarno, author of “The Divided Mind” and “Healing Back Pain: The Mind-Body Connection” and a New York University professor of rehabilitation medicine, the study validates his surgery-isn’t-the-answer position. “If you leave most patients alone, they’ll get better,” he says. He considers the pain attributed to herniated disks a symptom of another painful condition, called Tension Myositis Syndrome or TMS, from the “stress in our lives.”

Usually, herniated disk patients are in their early 40s—prime candidates to bounce back. Terry Rombalski, now 46, first hurt his disk six years ago, when he picked up his daughter. A couple weeks later, he took a practice golf shot and “bang,” he says, "shooting pain down my leg and lower back.” He talked to doctors and friends about surgery but decided against it. “The final analysis was, if the pain is at a point where you can’t function, you should have surgery,” he says. “Don’t do it unless you have to.” Instead, he took up yoga. “I can now go down and touch my toes,” he says. Though he needs to stretch for a while before he can lean over and tie his shoes in the morning, he is able to play golf again. He has no regrets about saying no to surgery. “I think it was the right move,” he says.

© 2006