Surgery Improves Outcomes for Spine Patients

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People with the spine disease called degenerative spondylolisthesis*—who choose surgical treatment—experience substantially greater relief from pain over time compared to those who do not have surgery, according to a study published in the June 2009 issue of The Journal of Bone and Joint Surgery (JBJS). In the past, physicians had been uncertain whether surgery provided significantly greater relief for patients, but these results help to confirm the advantages to surgery.

“There are thousands of surgeries completed each year to address degenerative spine conditions, yet, there has never been a large-scale trial to give us evidence that the surgeries really work, as compared to non-operative approaches,” said study author James Weinstein, DO, MS, Third Century Professor and Chair of the departments of orthopaedics at Dartmouth Medical School and Dartmouth-Hitchcock Medical Center.

Dr. Weinstein and his colleagues collected data from 607 men and women diagnosed with spondylolisthesis who were enrolled in the Spine Patient Outcomes Research Trial (SPORT), a multi-center study that included participants from 13 medical centers in 11 states. The study was the largest ever conducted of spondylolisthesis patients.

“Until this study, our ‘evidence’ was anecdotal and based on patient reports. We wanted data-based, scientific evidence that we could share with patients to help them make their decisions about taking an operative vs. non-operative approach,” Weinstein said.

Prior to completion of the study, SPORT looked at the three most common back conditions leading to surgery, which are:
• herniated disc;
• spinal stenosis; and
• spinal stenosis with degenerative spondylolisthesis.
To be included in the study, all patients had to meet certain criteria, including:
• nerve pain in the legs
• spinal stenosis revealed on cross-sectional imaging
• degenerative spondylolisthesis evident in radiograph imaging
• symptoms which lasted for at least 12 weeks
• physician confirmation that the patient was a surgical candidate.

“Our results indicate that in these patients, there was a clear advantage for surgery,” said Dr. Weinstein. “Patients felt relief faster and at two and four years, reported better function, less pain, and higher satisfaction than those who chose to go the non-surgical route.“

Approximately 80 percent of Americans suffer from back pain at some point in their lives. Back pain is the most common cause of work-related disability, as well as the most expensive in terms of workers compensation and medical costs. Degenerative spondylolisthesis is one example of this kind of painful back condition.

“Degenerative spine disease can be a debilitating condition. When well informed, surgery is a good treatment choice,” said Weinstein.

SPORT investigators will be releasing additional studies focusing on cost-effectiveness and other factors in coming months.

* Degenerative spondylolisthesis occurs when laxness in the spine causes one vertebra to slide forward and press against nerves, causing pain in the back and legs. The condition often occurs as a result of the aging process.

More Information: SPORT is the first comprehensive study to look at different ways of treating low back and leg pain and how effective they are for patients. The trial was funded by the National Institutes of Health (NIH) in recognition of how prevalent back problems are, and how disabling they can be. The research is meant to give patients and their physicians solid information to help guide them as they make decisions about how to treat their conditions. Approximately 2500 patients took part in the 5-year study.

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the Office of Research on Women’s Health, the National Institutes of Health, and the National Institute of Occupational Safety and Health, the Centers for Disease Control and Prevention. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Medtronic). Also, a commercial entity (Medtronic) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Source: American Academy of Orthopaedic Surgeons (AAOS)

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