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"I was naive, and in severe pain. I didn't think properly at the time," said Cortez, who felt worse after surgery. It took her six years to work up the nerve to try again, this time a fusion that mostly relieved the pain: "I have my life back."
Her new doctor cautions that scar tissue and altered anatomy mean each subsequent back surgery has less chance of success than the one before.
"It's like trying to pave your driveway, layer upon layer, but at some point you replace the whole driveway. We don't have that ability with the spine," said Dr. Alok Sharan, spinal chief at New York's Montefiore Medical Center.
He makes patients exhaust nonsurgical options first, knowing that about one in five who has one back operation will have another in a decade.
"Sometimes people jump to this and think it will be a cure-all, and then five years later you need another procedure. If you're only 40, that's a big deal," Sharan said.
What's the best advice? First, some types of back pain are accompanied by red flags that need immediate attention -- such as numb or weak legs or urinary problems. But for most people:
Don't expect an X-ray, MRI or CT until a month to six weeks has passed, unless the doctor suspects a more serious problem. Following that guideline is becoming a quality-of-care measure in many organizations.
Get back to normal activity as quickly as possible; the days of prescribed bed rest are over.
Patients with sciatica, pain radiating down the leg, have the best outcomes from those nerve-easing decompression surgeries, Deyo stressed. California's Rosen said three criteria determine chances of success: a scan that correlates with the pain site; the patient has some weakness; and specific pain occurs when the doctor raises and straightens the legs.
Herniated disks heal on their own over about two years, but surgery for a faster fix is reasonable in good candidates, he said.
Fusions are appropriate for far fewer patients, those with fractures, unstable or slipping spines, curvature of the spine and rare other reasons, Rosen said.
Deyo recently studied surgeries for stenosis, that painful narrowing, and found decompression surgery as effective and less risky than fusions, which are more complicated and costly.
A formal exercise program is especially effective if coupled with cognitive behavioral therapy that teaches patients to manage and function with pain, Deyo said.
What if surgery fails? Usually, it was the wrong operation or the wrong candidate, said Rosen, who sees one or two patients a week classified as having "failed back syndrome" because of multiple failed surgeries.
Always get a second opinion. Rosen, who founded the Association for Medical Ethics, also recommends asking about a doctor's ties to companies that make spine-surgery products. That way you'll feel assured that a recommendation to cut doesn't come from a too-cozy relationship.
Not a good candidate? A primary care physician can be a neutral adviser in helping navigate next steps. Patients with more challenging back problems may fare better at a multidisciplinary spine center with numerous specialists
-- in rehab and pain management -- under one roof.
"You don't want to leave them hanging," said Rosen.
Government back-pain overview:
Mayo Clinic: http://tinyurl.com/25k5ox
Association for Medical Ethics:
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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