Science / Medicine : Unnecessary Surgeries

At least half of the hundreds of thousands of operations on Americans with ruptured discs in their lower back probably were unnecessary, according to a study that further suggests that 90% of lumbar disc patients can be healed without surgery.

Dr. Jeffrey Saal of the San Francisco Spine Institute said the three-year study indicates surgeons should change their criteria for deciding whether to operate.

Neurosurgeons generally operate if a patient fails to respond to bed rest and has severe pain, leg weakness and diagnostic exams showing a fragment of the disc’s nucleus has broken through the disc wall and is pressing against a nerve root.

None of those criteria, Saal said, should be used as overwhelming evidence that surgery is needed. Instead, the decision should be based on the patients’ level of function and whether that can be improved by an aggressive, active rehabilitation program, he said.

Ironically, Saal prescribed surgery in one of the most famous back disc cases when football star Joe Montana fully ruptured a disc in 1986 and made a spectacularly quick recovery.

Saal reported the study, co-authored with his brother, Dr. Joel Saal, to the North American Spine Society in Colorado Springs, Colo., last Monday. It has been accepted by the medical journal Spine.

Saal’s treatment included “back school” to teach patients how to reduce the risks of further injury, training for spine stabilization and exercises to develop overall body strength and flexibility while the disc heals itself.