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Two Fixes for Bad Backs


4 Star

Two Fixes for Bad Backs

Our Review Summary

This magazine column about the treatment of worrisome sciatica nicely summarizes the results of a recent Dutch trial comparing surgery to nonsurgical care. As the author notes, virtually all of the participants in both arms of the study were doing reasonably well one year after treatment. “It’s nice to know that if you must have a problem like sciatica, at least it’s one of those rare conditions that have not just one good solution, but two,”  notes the columnist. However, readers might come away confusing back pain with sciatica, and thinking sciatica is a bigger problem than it is.  They might also draw mistaken conclusions about how speedy the pain relief is with surgery; more detail on its small incremental benefit would be helpful. (See Quantification of Benefits of Treatment” above.) Finally, no independent expert sources are cited or quoted.  The use of the author’s wife as a case study in sciatica may have a biasing influence in favor of surgery for some readers.  


Does the story adequately discuss the costs of the intervention?


The column notes that surgery costs “a few thousand dollars,” and implies that nonoperative care is less expensive but does not specifically cite its cost.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story says surgery helped patients get better faster. But it does not say how much better or how much faster. Patients actually reported worse disability in the first four weeks after surgery . Surgery showed its greatest benefit between weeks 8 to12, and more modest outcomes through week 36.

Does the story adequately explain/quantify the harms of the intervention?


The article describes some of the common harms of disc surgery, including bleeding and nerve damage.

Does the story seem to grasp the quality of the evidence?


The story gives a reasonable accounting of the evidence in the new Dutch trial comparing operative to nonoperative management of sciatica.

Does the story commit disease-mongering?


Sciatica can be a debilitating problem. It is characterized by buttock and/or leg pain caused by a herniated disc. It should not be confused with garden-variety back pain. As the column notes, the two conditions occasionally overlap (“Back pain, including sciatica, is one of the leading causes of workplace absenteeism, and the fifth leading cause of hospital expenditures…”). But in lumping the two together, the column may easily lead readers to believe that sciatica is a bigger problem than it is. 

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

No independent expert source is cited or quoted.  The author used his wife as a case study in sciatica, possibly biasing some readers in favor of surgery.  



Does the story compare the new approach with existing alternatives?


The column nicely summarizes the similarly good outcomes of treatment with either surgical or nonsurgical care.

Does the story establish the availability of the treatment/test/product/procedure?


This column makes it clear that the treatments for sciatica—surgery and nonoperative care—are widely available.

Does the story establish the true novelty of the approach?


The reader can readily glean that disc surgery has been around a long time.

Does the story appear to rely solely or largely on a news release?

Not Applicable

We can’t judge if the story relied solely or largely on a news release.  No source is cited except a New England Journal of Medicine study.

Total Score: 7 of 9 Satisfactory


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