Back Pain: Surgery Appears to be Superior to Exercise, Therapy

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The updated results of the Spine Patient Outcomes Research Trial (SPORT) appeared in the December 1 issue of Spine. This study added 2 additional year on to the previously published 2-year results of research that had found that spine surgery out performs nonsurgical interventions for patients with lumbar disk herniation. Spine surgery does so by providing more rapid and greater relief in back pain symptoms and a greater improvement in function.

SPORT compared outcomes of 1244 patients at 13 American spine clinics. Each patient had at least a 6-week history of a herniated disk in the lumbar spine causing back pain, leg pain, and other symptoms. Patients were assigned into two groups: one group received either surgery (standard open diskectomy) and the other group received nonsurgical treatments (included at least active physical therapy, counseling with home exercise instruction, and nonsteroidal anti-inflammatory drugs if tolerated).

When asked for comment on these new findings from SPORT, James Bean, MD, president of the American Association of Neurological Surgeons, said "They've held up for 4 years, they've correctly identified the flaw in the reasoning, and I think it's a well-done paper. I agree with everything that was concluded."

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Surgery does not get patients back to work faster than nonoperative approaches. Work status is often seen as an important measure of success in spine-surgery patients. The study authors note "However, return to work appears to be independent of treatment received and does not follow improvements in pain, function, or satisfaction with treatment."

It is important to note that all patients in the study improved. Patients who don't want an operation, who are willing to do the physical therapy, home exercises, and anti-inflammatory drugs will improve.

It is estimated that up to 80% of Americans will be affected by back pain at some point in their life. The estimated cost of back pain care - including surgical and nonsurgical interventions - is about $100 billion a year.

There is mounting evidence that surgery might be more cost-effective than non-surgical treatment for back pain. This will need to be looked at over a longer period of time than 2 yr or 4 yrs to be sure.

Sources
Medscape News
Spine. 2008;33:2789-2800. Abstract
Ann Intern Med. 2008;149:845-853 Abstract, 901-903. Abstract

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