Back surgery brings no guarantees

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.

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 Friday, Dec. 19, 2014 Split Moon The day is split between the Scorpio and Sagittarius moon. The emphasis in the earlier hours is on introspection and what’s going on beneath the surface. The later hours have to do with confrontation and being willing to express observations. These are the last days of the season, and there is much to be resolved in the hours to come.

ARIES (March 21-April 19). You may feel awkward in a situation, but it’s training. The charming people haven’t lived charmed lives; rather, the adversity they faced helped them mold their personalities in a way to warm up the harsh world.

TAURUS (April 20-May 20). If you have a weak connection with a person, it will be difficult to get your point across. Just as phones need to lock onto a common wire or satellite, you need to find common ground before you can proceed effectively.

GEMINI (May 21-June 21). Maintaining your friendships is important, but don’t expect them to stay the same. You enjoy different things from what you did when you were younger, and your relationships accommodate these new interests. our own education, training and clinical experience to make those decisions.

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 morerecent 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 Keith Roach, M.D.

CANCER (June 22-July 22). Defending your point of view against those who will likely never share it is a waste of time. Instead, build your community of likeminded thinkers. Together you’ll be powerful.

LEO (July 23-Aug. 22). The goal is to live peaceably, so it’s a little strange that in order to do so you have to have a confrontation. Take a breath. Through clear communication, you will effectively handle this.

VIRGO (Aug. 23-Sept. 22). Common decency perhaps isn’t as common as it should be. That’s why a certain person is now standing out to you -- someone who continually takes the high road in even the smallest matters.

LIBRA (Sept. 23-Oct. 23). You’ll live some of life’s dichotomies firsthand. Without danger, there is no adventure. Without risk, there is no excitement. Without fear, there is no courage.

SCORPIO (Oct. 24-Nov. 21). If you can’t start by taking on the task (because you’re unready, untrained or because you don’t have the resources), you can start by looking the part, and eventually you’ll get there.

SAGITTARIUS (Nov. 22-Dec. 21). People think you’re good at working the room, but really your magic starts before you ever enter the room. The key to social situations is in your attitude: warmth all the way. 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.

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. Why break the ice when you can melt it?

CAPRICORN (Dec. 22-Jan. 19). When you find solid relationships, you cherish them. There is a limit to how many people you can fit in your inside circle and still have time to cherish each one.

AQUARIUS (Jan. 20-Feb. 18). Caring about the details will give you an advantage. People notice that you’re noticing. They feel tended to because you’re handling the small matters that contribute to everyone’s comfort.

PISCES (Feb. 19-March 20). It’s not always easy for you to tune into what is going on in your own emotional landscape, but the time and effort it takes to figure it out will be worthwhile. When you can manage yourself, you can manage others.

TODAY’S BIRTHDAY (Dec. 19). It’s your year to be playful and laugh more. In January, a special interest colors your outlook on relationships and life. Love will thrive. In March, you’ll change to become a better you, and they’ll reap the benefits, too. Your teamwork will help to bring a victory in June. The children you know make summer great. Aries and Virgo people adore you. Your lucky numbers are: 4, 22, 14, 30 and 19.

WEEKEND LOVE FORECAST: ARIES: Before you invest in those expensive new boots, consider that healthy and stress-free is the best look of all. TAURUS: Appearances and behavior do not always reflect what’s really going on with a person, but conversing for five minutes will give you a feel for the whole story. GEMINI: Dancing is one of the best ways to get to know someone this weekend. CANCER: When his protective instincts are triggered, he’s hooked. When she feels protected, she’s hooked. LEO: You feel better about what you can control than what you can’t, and this weekend is about noticing the difference. VIRGO: Much gets accomplished with a soft voice. LIBRA: You accept yourself, but you also want to evolve -you can do both at the same time. SCORPIO: A carefree attitude is not the same thing as a careless attitude. You’ll gravitate to the former and avoid the latter. SAGITTARIUS: What people say in jest speaks to how they really feel, so listen up. CAPRICORN: Stay on top of your typical reactions. There’s one you might want to change because it’s no longer necessary and because you’ll be more effective in a relationship if you do it differently. AQUARIUS: You’ll spend time with someone who respects silliness as much as you do. PISCES: Keep track of the way a relationship is playing out day to day. Later this will be meaningful.