Surgery Better Option For Common Back Conditions New Studies Suggest

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Surgery Better Option For Common Back Conditions New Studies Suggest

http://www.medicalnewstoday.com/healthnews.php?newsid=72643

Slipped vertebra and sciatica are some of the most common conditions

seen by doctors in patients with back problems and two new studies

suggest that timely surgery is a better way to treat them than non-

surgical remedies.

The studies are published in today's edition of the New England

Journal of Medicine (NEJM).

Degenerative spondylolisthesis (DS, also known as slipped vertebra

or slipped disk) is where one or more verterbra in the spine become

misaligned and press on nerves in the spinal cord, resulting in

severe leg pains. It generally occcurs after the age of 50. It

affects around 600,000 Americans and is seen six times more often in

women than in men; it is especially prevalent among African-American

women.

On its own DS is usually symptom-free, but sometimes it affects the

spinal canal, making it narrower (spinal stenosis) which puts

pressure on the nerves resulting in pain in the legs, such as when

going for a walk.

The first NEJM study, led by researchers at the Dartmouth Medical

School, Lebanon, New Hampshire, US, showed that surgery was twice as

effective as non-surgical treatment in reducing pain and helping

patients with DS and spinal stenosis get back to normal.

Before this study, there were no controlled trials on the

effectiveness of surgery to treat DS with spinal stenosis.

The researchers recruited 607 patients from 13 medical centres in 11

US states who had at least 12 weeks of symptoms which had been

confirmed as DS. They were assigned to either a randomized cohort or

an observational cohort.

The outcomes were measured using a range of medical, disability,

general health and pain assessment questionnaires at 6 weeks, 3 and

6 months, and at 1 and 2 years.

The results showed that 372 patients had surgery within two years

(decompressive laminectomy, with or without fusion) and 235 had non-

surgical treatments that included physical therapy, steroid

injections, and drugs.

Two years after enrollment, patients who had received surgical

treatment reported significantly reduced pain and improved

functionality as early as six weeks after intervention, while those

who did not receive surgery reported only modest improvements.

The researchers concluded that:

" In nonrandomized as-treated comparisons with careful control for

potentially confounding baseline factors, patients with degenerative

spondylolisthesis and spinal stenosis treated surgically showed

substantially greater improvement in pain and function during a

period of 2 years than patients treated nonsurgically. "

Sciatica is often caused by displaced spinal disks putting pressure

on the sciatic nerve resulting in painful burning sensations or

numbness down one side of the body, mostly in the leg. 75 per cent

of cases resolve on their own without surgery, but worldwide around

1.5 million operations are carried out to remove all or part of the

disk to relieve the pressure on the sciatic nerve.

The second NEJM study, led by Dutch researchers based at Leiden

University Medical Center, showed that microdiskectomy surgery

relieved pain faster than conservative treatments based on physical

therapy and drugs, although 95 per cent of sciatica patients were

free of pain within 12 months whether they had surgery or not.

Patients with sciatica are often referred to surgery if the symptoms

persist more than 6 weeks, but there is little well researched

information on the best time to have the operation.

The researchers randomly assigned 283 patients who had been

experiencing severe sciatica symptoms for 6 to 12 weeks to one of

two groups. The first group was referred for early surgery while the

second group had prolonged conservative treatment (physical therapy

and drugs), with surgery if needed. Both groups were monitored using

questionnaires about disability, leg pain, and perceived recovery in

the first year of the trial.

125 (89 per cent) of the 141 patients referred for early surgery had

a microdiskectomy after an average of 2.2 weeks. 55 (39 per cent) of

the 142 patients who were referred for prolonged conservative

treatment had surgery after an average of 18.7 weeks.

The results showed no difference in overall disability scores during

the first year. However, relief from leg pain was faster among the

early surgery patients, and this group also reported a faster rate

of perceived recovery. But after one year of follow up, the

percentage of patients who described themselves as recovered was the

same, at 95 per cent.

The researchers concluded that:

" The 1-year outcomes were similar for patients assigned to early

surgery and those assigned to conservative treatment with eventual

surgery if needed, but the rates of pain relief and of perceived

recovery were faster for those assigned to early surgery. "

" Surgical versus Nonsurgical Treatment for Lumbar Degenerative

Spondylolisthesis. "

Weinstein, N, Lurie, Jon D, Tosteson, Tor D, Hanscom, Brett,

Tosteson, NA, Blood, A, Birkmeyer, JO, Hilibrand,

Alan S, Herkowitz, Harry, Cammisa, P, Albert, Todd J, Emery,

Sanford E, Lenke, Lawrence G, Abdu, A, Longley, ,

Errico, J, Hu, Serena S.

N Engl J Med 2007 356: 2257-2270