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 report Thursday.
The study, published in the New England Journal of Medicine, gives “us more confidence in recommending surgery to our patients,” said Dr. Mark Spoonamore of the University of Southern California’s Keck School of Medicine. The recommendation is “not just our gut feeling, but based on a strong scientific foundation.”
Dr. Arya Shamie of the University of California, Los Angeles’ 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 now undergo surgery, according to Dr. James Weinstein of the Dartmouth-Hitchcock Medical Center in Hanover, N.H., who led the study.
The bulk of the patients are over 50, and women are six times as likely as men to suffer from it, with black women at greatest risk.
Conventional treatment involves physical therapy, steroids to reduce swelling and anti-inflammatory drugs. But only about 20 percent of patients get better and 20 percent 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 alone totaling more than $21 billion per year, according to Dr. Richard Deyo of the University of Washington.
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