Surgery should be treatment of last resort

DEAR DR. ROACH: Around two years ago, I had an L4/L5 herniated disc that caused a sciatic nerve problem. My doctors tried prescription medication (including medicine to act on the nerves), two lumbar injections and physical therapy. I also tried a chiropractor and acupuncture. After all of the above steps, my back pain has basically gone away, with the exception of numbness/tingling in my right foot. This numbness/tingling varies in intensity from light to strong. I have been reading about spinal decompression, but at this point, I am not sure what else to do. Do you have any recommendations? — M.B. ANSWER: I do not recommend spinal surgery for numbness and tingling. Although most people do well with surgery, I have seen enough people have bad outcomes after surgery (including weakness and intractable pain) that I recommend surgery only with pain so severe that it can’t be effectively treated; with weakness (immediately, if the weakness is progressing); or with symptoms affecting the bladder or bowel. All of these only after optimal nonsurgical treatment for at least six weeks). Virtually all spine surgeons I have worked with are very cautious and conservative about recommending surgery (that is partially because I tend to refer to surgeons who do not easily recommend operating). Most people will find that the numbness and tingling go away, but two years is a long period of time. I understand why you might be frustrated.

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 send mail to 628 Virginia Dr., Orlando, Fla., 32803.