When should surgery be used?

Over the last two decades, orthopedists have made great strides in establishing nonsurgical treatment for low back pain, a condition affecting almost 80% of Americans at some point in their lives, indicates Edward N. Hanley, Jr., chairman of the Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, N.C. Many of those can be treated nonsurgically with instruction about how the back works, a carefully planned exercise program, and use of medication to decrease inflammation.

However, surgery can provide relief for specific back problems experienced by a small segment of the population such as sciatica, a painful condition in the hip or thigh resulting from a herniated disc. Orthopedists use the following criteria in considering surgical intervention for sciatica: severe pain in the leg, failure to improve after four to eight weeks of nonsurgical treatment, and confirmation that the disc is herniated by use of an imaging test such as a CAT scan or an MRI.

They also should evaluate smoking history, age, and even mind-set (job satisfaction, emotional distress, etc.) when...