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Sciatica: whether to have surgery or not SCIATICA: WHETHER TO HAVE SURGERY OR NOT
Just because you're referred to a surgeon does not necessarily mean that an operation will be performed or even suggested. Surgeons will invariably make their own assessment of what they think is best. Although surgeons as a group do tend to have a bias towards their own speciality, they do also recognise that an operation is not always the best nor only answer. It is not rare for someone who was referred to a surgeon to then later on be referred to yet another specialist because the surgeon concluded that this was a case where less intrusive treatment might work just as well.
If surgery remains indicated, there are numerous possible procedures with an excellent track record. However, it also has to be pointed out that every form of surgery carries its own set of risks.
The decision to undergo an operation should therefore always be weighed up most carefully.
To help you make up your own mind about having an operation if one is offered, The National Back Pain Association suggests a number of questions you should ask your surgeon, these including:
What is my exact diagnosis?
Do I have signs of nerve root compression? And are the symptoms that I have directly related to nerve compression?
What are my chances of good pain relief if I opt for a surgical intervention?
Are there any alternatives to conventional surgery that I could try?
How many of these procedures have you performed? What is your success rate for the surgery you have offered me?
What the NBPA is essentially saying through these suggestions is that any patient should make sure that the problem has been fully and accurately diagnosed, that an operation is likely to yield a good result, and that the surgeon is fully experienced in the intended procedure.
Additionally, the NBPA suggests that "the decision as to whether to have surgery and what type, is difficult, and needs very careful consideration. The only person who can really answer your questions about the effectiveness of surgery for your particular problem is your own surgeon. Ensure that you attend appointments well-prepared with your questions written down and, preferably, with someone else to listen to the response.
A similar message comes from the Agency for Health Care Policy and Research, a part of the Department of Health and Human Services in the USA, which somewhat more bluntly states:
Even having a lot of back pain does not by itself mean you need surgery.
Surgery has been found to be helpful in only 1 in 100 cases of low back problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.
People with certain nerve problems or conditions such as fractures or dislocations have the best chance of being helped by surgery. In most cases, however, decisions about surgery do not have to be made right away.
Most back surgery can wait for several weeks without making the condition worse.
If surgery is recommended, be sure to ask about the reason for the surgery and about the risks and benefits you might expect.
You may also want to get a second opinion.
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