Surgery is twice as effective as physical therapy and drugs for relieving pain and improving mobility in one of the most common back problems, researchers reported today.
The study, published in the New England Journal of Medicine, gives "us more confidence in recommending surgery to our patients," said Dr. Mark J. Spoonamore of USC's Keck School of Medicine. The recommendation is "not just our gut feeling but based on a strong scientific foundation."
Dr. Arya Shamie of UCLA's David Geffen School of Medicine added, "This is a great study ... confirming what doctors have believed all along."
The condition, called degenerative spondylolisthesis with spinal stenosis, occurs when one lumbar vertebra in the back slips forward relative to the one next to it, pinching the spinal cord and producing severe pain in the legs.
The condition affects as many as 600,000 Americans, although only about half of those seek medical treatment and perhaps only a quarter of them undergo surgery, according to Dr. James W. Weinstein of the Dartmouth-Hitchcock Medical Center in Hanover, N.H., who led the study.
The bulk of the patients are older than 50, and women are six times as likely as men to suffer from it, with African American women at greatest risk.
Conventional treatment involves physical therapy, steroids to reduce swelling and anti-inflammatory drugs. But only about 20% of patients get better and 20% stay the same without surgery, according to Shamie, who was not involved in the study.
Surgery relieves pain by removal of bone and soft tissue in a procedure called a decompressive laminectomy.
Because of the aging American population, back surgeries are one of the fastest-growing areas of medical care, with hospital costs totaling more than $21 billion per year, according to Dr. Richard A. Deyo of the University of Washington.
The federally funded study enrolled 607 patients at 13 medical centers in 11 states. Of those, 372 underwent surgery and 235 did not.
Two years after their enrollment in the study, the patients who did not undergo surgery reported only modest improvements in their condition.
Those who had surgery reported significantly reduced pain and improved functionality. Major improvements were seen within six weeks after the surgery. The most common complication of the surgery was a tear in the lining of the spinal cord.
