Imagine a jelly donut. In many ways, the flattish oval you have in mind is similar to the intervertebral discs that make up your spine. There is a solid outer layer that is filled with a soft, jellylike material in the center. These discs help cushion the bones of the spine and retain its flexibility. Over time, however, these discs may become prone to tearing or rupturing (imagine again that jelly donut with the inner filling squished out). When this occurs, it is called a herniated disc.

Herniated discs have been treated with many interventional treatments, but recently, one team of researchers undertook a large clinical trial to review the most effective treatments for this condition. In a study to be published in the journal Spine, these researchers compared the benefits of surgical intervention to nonsurgical treatments, such as physical therapy, to treat the pain associated with herniated discs.

After analyzing the data from over 1,000 patients in the Spine Patient Outcomes Research Trial (SPORT), researchers found that surgical treatments do produce greater improvements in pain and functioning. 

In the study, researchers randomly assigned half of the patients to discectomy surgery and the other half to nonsurgical treatment options, like physical therapy, exercise regimens, and pain medications. Patients were also allowed to “cross over” to the other treatment option during the course of the eight year study. Patients who underwent surgery had significantly lower rates of pain overall (11 points lower on a 100-point scale) than those who did not have surgery.

There is a caveat though. As researchers noted, many patients who chose nonoperative treatment did find significant improvement, especially those who were active in the decision-making process with their doctors. The SPORT Principal Investigator, Dr. James N. Weinstein, noted that:

“Every patient in the SPORT study went through shared decision-making, during which they reviewed objective information about the risks and benefits of their treatment options. This allowed them to make an informed choice, in line with their own values. That about a third of these patients have continued to be satisfied with their choice is in large part due, I believe, to their being active participants in the initial decision-making process.”

Have you had a herniated disc? How did you and your pain management team treat your condition? 

Image by Francis Bijl via Flickr


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