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When should surgery be used?

Over the last two decades, orthopedists have made great strides in establishing nonsurgical treatment for low back pain, a condition affecting almost 80% of Americans at some point in their lives, indicates Edward N. Hanley, Jr., chairman of the Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, N.C. Many of those can be treated nonsurgically with instruction about how the back works, a carefully planned exercise program, and use of medication to decrease inflammation.

However, surgery can provide relief for specific back problems experienced by a small segment of the population such as sciatica, a painful condition in the hip or thigh resulting from a herniated disc. Orthopedists use the following criteria in considering surgical intervention for sciatica: severe pain in the leg, failure to improve after four to eight weeks of nonsurgical treatment, and confirmation that the disc is herniated by use of an imaging test such as a CAT scan or an MRI.

They also should evaluate smoking history, age, and even mind-set (job satisfaction, emotional distress, etc.) when considering surgery for sciatica, especially if more than one of these factors is present. Studies have found that smokers, persons over 40, and patients covered by worker's compensation are not likely to respond well to such procedures.

"Some patients with more severe and chronic problems require a broad-based, multi-specialty approach," Hanley explains. "You could say that they are in need of surgery on their life--and, as doctors, we need to help them address their entire being, not just their back problem."

In recent years, new technological developments in back treatment have led to the utilization of anthroscopy, automated percutaneous disk removal devices, and lasers. However, Hanley stresses that, "even though these new approaches are innovating and exciting, the single most important predictive factor remains proper selection of the patient."
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Title Annotation:back pain
Publication:USA Today (Magazine)
Date:Feb 1, 1993
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