The study, done at 13 medical centers across the country, enrolled more than 1,700 patients who were surgical candidates for one of the three conditions. Some patients went under the knife; others had nonsurgical treatments such as medication, physical therapy or restricted activity.
Statistical analysis showed faster recovery in the surgical patients, though many nonsurgical patients experienced good recovery as well. All patients in the study were also experiencing sciatica, so the findings may not apply to people whose pain is only in the back.
Despite these results, there is a long-standing controversy among spinal specialists over how often surgery is the best option -- and some say surgeons can be too quick to sharpen their scalpels.
Part of the reason for the U.S.' high rates is probably cultural. "We're in a little bit of a quick-fix society," says Dr. Steven Richeimer, chief of the division of pain medicine at USC. Doctors may also be seduced by flashy new drugs or devices because they genuinely want to help their patients, says Dr. Richard Deyo, an internist at the Oregon Health and Science University in Portland.
But many surgeries fail to heal the pain. Doctors even have a name for the problem -- failed back surgery syndrome.
The exact success rate for surgical intervention is difficult to calculate, but Deyo notes that approximately 20% of surgical patients will have another surgery within a decade, indicating that the first operation was unsuccessful.
Part of the problem is that the exact cause of the pain isn't always known. For most back pain patients, Deyo says, doctors cannot discern a specific cause. And advanced imaging techniques -- though popular -- may be misleading.
"When you do magnetic resonance imaging or computerized tomography scans of the spine, you sometimes see horrible things in normal people," Deyo says. One-fourth of people under 60 have a herniated disc, he says, and half have a bulging or degenerated disc. "And yet these are people who have no back pain."
Those deformed discs may look like trouble to surgeons, though, so they may remove a disc that wasn't even causing pain -- leaving the real problem unaddressed.
The vast majority of injured discs will heal without surgery, Hayden says. In addition, surgery carries its own small risk for complications, such as nerve damage or a tear in the tissue around the spinal cord, which could mean lasting numbness or further surgery.
