From: Reuters
Published February 20, 2008 05:06 PM

Surgery helped patients with common spine ailment

By Julie Steenhuysen

CHICAGO (Reuters) - People who had surgery for spinal stenosis -- a common back ailment -- had less pain two years later than those who decided to skip the surgery, U.S. researchers said on Wednesday.

They said the study, published in the New England Journal of Medicine, should help patients make an informed decision when they develop the painful condition.

"This study says surgery is better," said Dr. James Weinstein of Dartmouth College in New Hampshire.

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Spinal stenosis is the most common cause of lumbar surgery in people over 65. It is caused by a narrowing of the spinal canal that gradually pinches off nerves in the spine, making it painful to stand or walk.

The findings are part of a five-year, 11-state study known as the Spine Patient Outcomes Research Trial, looking at the effectiveness of common back surgery.

An earlier part of that study found patients with painful herniated disks in the lower back typically recover with or without surgery, although surgery helped relieve pain faster.

Weinstein said the spinal stenosis part of the study showed that while surgery patients fared better even after two years, patients who skipped surgery were able to live with their pain. "They do have a choice," he said in a telephone interview.

"Non-surgical therapies or watchful waiting are options. What is most important is that we engage our patients in the decision making process and offer them an informed choice."

LITTLE RELIEF

A large study published last week found Americans with back pain are not getting much relief despite annual spending of $86 billion on popular spine treatments.

Weinstein and colleagues looked at 289 patients who were randomly selected to have either surgery or non-surgical care, which included physical therapy and pain medication.

Many patients nonetheless decided to make their own choice about treatment. After two years, 67 percent of patients assigned to have surgery actually got it done. And 43 percent of the patients assigned to skip surgery had it anyway.

Patients who got the surgery had less pain two years later, but there was no significant improvement in physical function or disability.

Weinstein said the patients who crossed over to the surgery group had reported more severe pain and were in more distress. Patients who delayed the surgery in general has less severe symptoms.

While this cross-over limited the study's power, Weinstein said both groups clearly benefited from surgery.

A second group of 365 patients were allowed to choose which treatment they preferred.

When the researchers combined data from both groups, they found people who got surgery fared better in all measures: less pain, more physical function and less disability.

(Editing by Maggie Fox and Cynthia Osterman)

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