Ask Dr. Strothman: When Is Surgery Effective For Pinched Nerves?
When you have pain caused by a pinched nerve, it can be challenging to evaluate your treatment options. Although nonsurgical treatment is effective for 90 percent of spine pain, there are some specific conditions that are best treated by surgery.
A pinched nerve can occur in a variety of ways. “You can get a pinched nerve with or without a slip in the bones of the spine,” explains Summit spine surgeon Dr. David Strothman. “Slippage between spinal discs was traditionally treated with fusion surgery. However, researchers wanted to compare surgical outcomes for pinched nerves with outcomes for pinched nerves combined with disc slippage. Additionally, they wanted to compare both surgical outcomes to the outcomes of patients who opted not to have surgery.
“The condition where one spinal disc slips forward on another is called spondylolisthesis,” says Dr. Strothman. “The classic gold standard treatment for a pinched nerve and spondylolisthesis is decompression and fusion surgery. However we didn’t have good data about how surgical outcomes compared to conservative treatment outcomes. That was until the Spine Patients Outcome Research Trials. These trials, commonly referred to as the SPORT studies, tracked surgical outcomes. It compared the results for surgical patients with the results for patients who elected not to have surgery.”
Tracking surgical outcomes
The SPORT data demonstrated excellent surgical outcomes for patients with pinched nerves and for patients with pinched nerves complicated by spondylolisthesis:
- When patients with pinched nerves and spondylolisthesis were treated with decompression and fusion surgery after failing three months of conservative treatments, they did markedly better than patients who never received surgery.
- These surgical patients actually returned to their age-matched control levels of function by six months.
- Patients with this condition who didn’t have surgery didn’t get better.
- Patients who have pinched nerves uncomplicated by spondylolisthesis also did better with surgery than patients who receive only conservative treatments. However they did not do quite as well as patients with both pinched nerves and spondylolisthesis.
- The research further showed that the six-month benefits of surgery were maintained for four years.
“When patients with these spine conditions are treated with surgery, not only do they get better, but the improvement also is maintained year after year,” says Dr. Strothman. “Although patients with only pinched nerves don’t do quite as well after surgery as patients surgically treated for pinched nerves and disc slippage, they still did really well, and a lot better than patients who opted not to have surgery at all.”
Other recent studies have compared decompression and fusion for stenosis and spondylolisthesis (the condition characterized by pinched nerves and a slipping bone) to the results of total hip and total knee arthroplasty. “Total knee surgeries provide some of the greatest returns of function of any operation done,” explains Dr. Strothman. “We learned that the gold standard surgery for spondylolisthesis and stenosis improved quality of life as much as a total knee replacement. This is remarkable. Thanks to SPORT research, today we understand that a decompression and fusion surgery for a pinched nerve and spondylolisthesis can provide one of the best outcomes in medicine. It improves and maintains a person’s quality of life.”
More resources on pinched nerves
“Spinal disorders are complex and disabling. As your surgeon I will explain your diagnosis and treatment options, both operative and non-operative, in a way that you can understand thereby allowing you to make informed decisions. I am rewarded daily by improving the quality of life of patients receiving my care.”
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