Back Pain: To Cut or Not to Cut

Each year, about 300,000 Americans have surgery for herniated disks, at a cost of $10,000 to $15,000 per procedure. Is it worth it? Maybe. And maybe not. A report in last week's Journal of the American Medical Association (JAMA) found that patients with severe leg pain who did not have surgery improved nearly as much as those who went under the knife. Differences in outcome over a two-year period were described as "small and not statistically significant." Either way, "patients got remarkably better," says Dr. David Flum of the University of Washington.

So, who should get surgery? Patients need to examine their priorities, says Dr. Rick Deyo, co-author of the JAMA report. "Are you risk-averse and prefer to avoid surgery? If so, you'll probably get better. Are you a risk taker and prefer surgery? If so, you'll probably get better faster, and it'll cost a bit more."

For some patients, letting nature take its course may be best. "Can you do your work?" asks Dr. Richard Guyer, head of the North American Spine Society. "If the answer is yes, don't do surgery." But someone who is unable to function may prefer the immediate relief of an operation, recognizing that even herniated-disk surgery, which is much simpler than spinal fusion, carries some risk. Internet marketing consultant David Haas, 45, says he will never forget the "knifing, searing pain" in his calf. Sometimes his wife had to drive him the 250 steps from his home to his office. He chose surgery. "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." Robert Jacobs, 76, opted not to have surgery, despite "constant, unremitting" pain. "It was an unpleasant six months," says Jacobs, "but it did resolve itself." He now spends two hours in the gym every other day, proof that the OR is a choice, not a necessity.