Two years ago I had severe, terrible back pain from a large herniated disc. I had surgery and was much better within six weeks. Yesterday I read in the paper where a big study showed that people with disc problems get better just as often without surgery. I’m wondering if I should have just waited it out. But the pain was so bad, I don’t know if I could have waited.

You may be referring to a large randomized study called the SPORT study. SPORT stands for Spine Patient Outcomes Research Trial. The study was supposed to report on the results of patients treated for lumbar disc herniation. Results from surgery were compared with results from nonoperative care.

The reported results may have been a bit misleading. And the study design may have been a bit off as well, according to Dr. Paul McCormick, a neurosurgeon from Columbia University. Dr. McCormick published a thorough review of the study.

He pointed out that it’s not really possible to get a Yes or No answer to the question of whether having surgery is better than not having surgery for this condition. Not all disc herniations are the same. Not all patients are the same.

And even if the answer turned out to be that surgery was better for herniated discs, it still doesn’t mean everyone with a disc problem should have surgery. If it turned out that conservative care was better, would anyone be allowed to have surgery? Of course…so the findings as presented were a bit misleading.

The biggest misunderstanding occurred because some patients assigned to the surgical group decided not to have the operation after all. And some patients in the nonoperative group decided to crossover to the surgical group. But the results in the end were still reported as if they were part of the group they started in, not the group they ended up in.

The crossover rate was high in this study. This factor reduced the study’s ability to detect a difference between the two types of treatment. Patients with severe symptoms who have surgery often get pain relief quickly. The results measured by pain levels, function, and disability may not be much different from those who didn’t have surgery.

But from the SPORT study, we know that patients with mild symptoms gravitate toward conservative care. They don’t really need surgery. It takes a little longer to recover but the final results are often the same compared to patients with severe pain from lumbar disc herniation treated surgically.