2006年NPR美国国家公共电台三月-For Back Pain, Few Easy Answers on Surger

Renee Montagne: Hundreds of thousands of Americans have back surgery every year at a much higher rate than any other country. Whether there are too many back surgeries is a hotly debated subject in orthopedist, NPR's Joanne Silberner examines the question of who should get surgery for lower back pain.

Joanne Silberner: 34-year-old real estate broker 1 and amateur triathlete, Noah Hano has had back problems for almost 20 years.

Noah Hano: The first time I hurt my back, I was working in a, in a grocery store, stocking shelves and I went to go lift a box , and something popped and I fell to the ground and it was about 3 or 4 days of not really being operative well function or move.

Joanne Silberner: 37-year-old organic farmer Peter Griffin also has his history.

Peter Griffin: I've had back pain for many years. The last six or eight months, my back pain increased sharply, it went from being, you know, um, a bad pain to a worse pain.

Joanne Silberner: He couldn't sit or bend over, a tough situation for a vegetable farmer. Each consulted Dr. James Weinstein at Dartmouth medical school, one of the nation's leading experts on back pain. In fact, Weinstein has had back pain himself.

James Weinstein: I couldn't believe it. I was in the post office, getting my mail, bending over to my post office box and I couldn't get up. And I said this couldn't be happening to me. I am supposed to be the expert. And I literally 2 had to crawl from parking meter to parking meter to get back to my car.

Joanne Silberner: Weinstein's diagnosis 3 for both Hano and Griffin went straightforward 4. Each had a herniated disk. But knowing that didn't make the treatment decision easy.

James Weinstein: If somebody has a broken hip 5, it's not a toss-up. You have surgery. There isn't a question about what to do. If you hurt your back, that's a toss-up, because there is all kinds of treatments.

Joanne Silberner: There is spinal 6 fusion 7, fusing vertebra together, a discectomy, removing part of a leaking disk. There is a laminectomy, freeing up a pinch nerve. Or no surgery at all, a combination of a watchful 8 waitingand working through the pain. Weinstein wouldn't tell his patients what to do. Peter Griffin.

Peter Griffin: He specifically said to me that he didn't want to make a recommendation one way or another. This was a decision you know, I need to make in the context of my life and the context of, you know, the concerns I have.

Joanne Silberner: Weinstein gave Griffin and Hano the same information, all really that there is to offer right now. Two studies, one a twenty-year-old publication from Norway showing that one year after consulting in orthopedist, 36% of the people who didn't have surgery had improved, compared to almost twice as many who had surgery. But at ten years out the numbers were about equal. Hano who decided 9 not to have the surgery thought about the ten year number.

Noah Hano: For me, you know, that, that was, that was all I needed to hear. As long as I can continue to function and I knew that there was some hope that I would, you know, that I'd recover from it then. Then I was definitely gonna take the non surgical 10 route.

Joanne Silberner: He has occasional pain, but it is not stopping him.

Noah Hano: I am currently training for iron man quarter lane which is June 25th of this year and I am looking forward to it. That will be my first iron man distance race.

Joanne Silberner: Griffin heard his doctor's one year numbers.

Peter Griffin: If I didn't have small children that, you know, I needed to chase after and lift on my shoulders and stuff, I might have made a different decision, I might have given the back more time.

Joanne Silberner: Orthopedist surgeons and non surgeons across the country are facing the same issues Weinstein everyday.

John Starf: Decision?

Joanne Silberner: This day, orthopedist surgeon, John Starf is doing a back surgery at Washington Hospital Center in Washington DC.

John Starf: He's got a critical change over back. He's got deformity. And he's got pressure on nerves.

Joanne Silberner: His patient is on his stomach, completely draped. All that is visible is an 8 inch by 4 inch swatch of his back. Starf is going to remove material that is blocking the nerve canals that branch of the spinal cord.

John Starf: We are gonna take stuff away. On roof, open up those cannels, you know, cut the belt that is too tight.

Joanne Silberner: That is a decompression. And how structurally 11 stabilize 12 the spine 13 with hardware? That looks just like that, hardware. Later, back in his office, Starf says in many cases, doing back surgeries is easier than deciding if back surgeries should be done.

John Starf: I don't have the answer for the vast majority of patients. I have alternatives. And together, I'll hope to find, find the answer.

Joanne Silberner: The bottom line right now? Patients need to be involved in deciding whether or not to have surgery. Weinstein says involving patients in the decision may even help their outcome, whatever they decide.

James Weinstein: You lower the level of anxiety; you lower the level of fear. I think that those patients who have a preference and feel in power might do better.

Joanne Silberner: Weinstein is heading a federal financed study of 1200 patients with chronic 14 lower back pain to compare the benefits of surgery versus 15 non-surgery. Results are due this summer.

Joanne Silberner: Joanne Silberner, NPR News.

Renee Montagne: If you'd like to ask Dr. James Weinstein a question, go to npr.org and look for the link that says 'Send us your questions on back pain'. Next week we will post online Dr. Weinstein's responses to 'Ask Dr. Weinstein.'

Note------------
[color=green]orthopedist: a doctor with special training in orthopedics;整形外科医师
herniate: 脱肠, 患疝气