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 broker¹ 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 literally² had to crawl from parking meter to parking meter to get back to my car.

Joanne Silberner: Weinstein's diagnosis³ for both Hano and Griffin went straightforward⁴. Each had a herniated disk. But knowing that didn't make the treatment decision easy.

James Weinstein: If somebody has a broken hip⁵, 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 spinal⁶ fusion⁷, 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 watchful⁸ 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 decided⁹ 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 surgical¹⁰ 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 structurally¹¹ stabilize¹² the spine¹³ 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 chronic¹⁴ lower back pain to compare the benefits of surgery versus¹⁵ 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

1 broker   

n.中间人，经纪人；v.作为中间人来安排

参考例句：

• He baited the broker by promises of higher commissions.他答应给更高的佣金来引诱那位经纪人。
• I'm a real estate broker.我是不动产经纪人。

2 literally   

adv.照字面意义，逐字地；确实

参考例句：

• He translated the passage literally.他逐字逐句地翻译这段文字。
• Sometimes she would not sit down till she was literally faint.有时候，她不走到真正要昏厥了，决不肯坐下来。

3 diagnosis   

n.诊断，诊断结果，调查分析，判断

参考例句：

• His symptoms gave no obvious pointer to a possible diagnosis.他的症状无法作出明确的诊断。
• The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做一次彻底的调查分析。

4 straightforward   

adj.正直的，坦率的；易懂的，简单的

参考例句：

• A straightforward talk is better than a flowery speech.巧言不如直说。
• I must insist on your giving me a straightforward answer.我一定要你给我一个直截了当的回答。

5 hip   

n.臀部，髋；屋脊

参考例句：

• The thigh bone is connected to the hip bone.股骨连着髋骨。
• The new coats blouse gracefully above the hip line.新外套在臀围线上优美地打着褶皱。

6 spinal   

adj.针的，尖刺的，尖刺状突起的；adj.脊骨的，脊髓的

参考例句：

• After three days in Japan,the spinal column becomes extraordinarily flexible.在日本三天，就已经使脊椎骨变得富有弹性了。
• Your spinal column is made up of 24 movable vertebrae.你的脊柱由24个活动的脊椎骨构成。

7 fusion   

n.溶化；熔解；熔化状态，熔和；熔接

参考例句：

• Brass is formed by the fusion of copper and zinc. 黄铜是通过铜和锌的熔合而成的。
• This alloy is formed by the fusion of two types of metal.这种合金是用两种金属熔合而成的。

8 watchful   

adj.注意的，警惕的

参考例句：

• The children played under the watchful eye of their father.孩子们在父亲的小心照看下玩耍。
• It is important that health organizations remain watchful.卫生组织保持警惕是极为重要的。

9 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

10 surgical   

adj.外科的，外科医生的，手术上的

参考例句：

• He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
• All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前，必须消毒。

11 structurally   

在结构上

参考例句：

• The house roof was (structurally) unsound. 这屋顶（结构）不牢固。
• Pinhole on shot-hole damage is never structurally significant. 针孔和蛀洞所造成的危害对结构的影响不大。

12 stabilize   

vt.（使）稳定，使稳固，使稳定平衡；vi.稳定

参考例句：

• They are eager to stabilize currencies.他们急于稳定货币。
• His blood pressure tended to stabilize.他的血压趋向稳定。

13 spine   

n.脊柱，脊椎；(动植物的)刺；书脊

参考例句：

• He broke his spine in a fall from a horse.他从马上跌下摔断了脊梁骨。
• His spine developed a slight curve.他的脊柱有点弯曲。

14 chronic   

adj.(疾病)长期未愈的，慢性的；极坏的

参考例句：

• Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
• Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。

15 versus   

prep.以…为对手，对；与…相比之下

参考例句：

• The big match tonight is England versus Spain.今晚的大赛是英格兰对西班牙。
• The most exciting game was Harvard versus Yale.最富紧张刺激的球赛是哈佛队对耶鲁队。