Back surgery brings no guarantees

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DEAR DR. ROACH: An MRI showed that I have severe stenosis of my C6 vertebrae. I have pins-and-needles sensations that often go down my right arm and in the neck area of my left shoulder.

I saw an orthopedic surgeon, who stated that he could “cure” my stenosis with a laminectomy surgery. Based on his recommendation, I have completed a six-day pack of prednisone and four weeks of physical therapy, with little diminishment of my symptoms. I am now taking Celebrex daily.

I have spent hours going through the various medical journals online but could not locate any journal article that summarizes the prognosis of this surgery. Do you know of any research that discusses the post-surgery results, including the degree to which symptoms are reduced and what percent of patients require further surgical interventions? It would be informative to know if there are any other options if PT has provided little benefit. — J.N.U.

ANSWER: As physicians, we like to practice evidence-based medicine, but the sad fact is that evidence to help guide us in the decisions we need to make often is lacking, so we are left with our own education, training and clinical experience to make those decisions.

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In this situation, we have a few studies to help us. The most-cited one, an analysis of two randomized, controlled trials, showed a faster improvement from surgery, but no difference in symptoms one or three years after surgery in the operation group, compared with the medication and physical therapy group. Several more-recent observational trials have shown significant improvement in pain and movement after surgery.

The real problem is that a population doesn’t go to see a doctor about neck pain — an individual does, and studies that examine population outcomes can’t give precise information about outcomes. Further, these studies don’t even apply to some people. For example, progressive weakness is a clear indication for surgery, and people with that complaint wouldn’t be considered for the trials. You still require an experienced surgeon to give you the best information he or she can about your condition.

It stands to reason that the more severe the pain and restrictions on activity, the more likely surgery is to help. Back surgery really should be contemplated only by people with moderate to severe symptoms, and those who recognize that, despite the best care, sometimes surgery does not help and, rarely, can make things worse.

DEAR DR. ROACH: I have heard of a number of different things to help acid reflux. Does raising the head of your bed fit into that category, and if so, by how much? — T.E.D.

ANSWER: Yes, raising the head of the bed can reduce symptoms of acid reflux. The traditional method is a brick or two under the head of the bed, but a wedge-shaped pillow works too. Using lots of regular pillows usually does not.

When we sleep, any acid that gets passed backward (refluxed) from the stomach into the esophagus stays there for a long time, since neither gravity nor the swallow reflex helps it down. With the head elevated, there is some gravity acting against reflux and getting it back into the stomach.

READERS: The booklet on macular degeneration explains this common eye ailment. Readers can order a copy by writing: Dr. Roach — No. 701, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

(c) 2014 North America Syndicate Inc.

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