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Conservative Therapy vs. Surgery for Lumbar Disc Herniations

Disc herniations can be overwhelming in terms of pain, emotional distress, and physical disability. Often times, even after a correct diagnosis, a patient is left with treatment choices that seem as clear as mud. Do I go see a chiropractor? PT? Pain management? An orthopedic/neurosurgeon? While all of the aforementioned professions are well equipped to help you on your journey, it really comes down to WHAT THE PATIENT WANTS AND NEEDS. And how can a patient be expected to make a decision without some knowledge regarding the different treatment options.


Below we will be discussing a research article published in 2016 by the British Medical Journal. This article studied the differences in recovery from lumbar disc herniations when patients underwent either conservative therapy ("ergonomic instruction, active physical therapy, education/counselling with instructions for home-based exercise") or surgery.


"Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation but did not show a benefit over conservative treatment in midterm and long-term follow-up." The 370 patients in the study were followed and evaluated at 6, 12, 52, and 104 weeks. The results of this study suggest that reduction in low back pain was more significant in the surgical group at 6 weeks, but that these differences in pain relief disappeared between the groups at 12, 52, and 104 weeks. Furthermore, the surgical group also experienced more physical function at 52 weeks, but these differences again disappeared between the groups at 104 weeks. This study demonstrates that LONG-TERM outcomes for lumbar disc herniations are similar when comparing surgery and conservative therapy.


This is great news considering the inherent risks and financial costs of invasive surgical interventions. Having said that, this is not claiming that EVERYONE with lumbar disc herniations should skip surgery and just do long-term physical therapy (in specific cases surgery is actually the best option). This simply isn't the reality of everyday life for most people. People have jobs to get back to. Vacations to take. Or sporting events to participate in. This is why the decision to treat a lumbar disc herniation has to consider the goals of the patient first and foremost.


Moral of the story is that you have options when it comes to treating a lumbar disc herniation. Find the option that makes the most sense for you. Make your healthcare provider aware of your specific situation and goals. Work TOGETHER with your healthcare provider to arrive at the best treatment option FOR YOU!


Reference:

Gugliotta M, da Costa BR, Dabis E, et al. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open 2016;6:e012938. doi: 10.1136/bmjopen-2016-012938

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