Surgery often unnecessary for low back pain

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Many people with lower back pain caused by spinal disc degeneration need not resort to surgery for relief, according to a research review.

In fact, researchers say, non-invasive treatments—including physical therapy and anti-inflammatory painkillers—should be the first, and often only, measure for most people with the problem.

Spinal discs can be damaged by trauma to the spine, repetitive strain on the back, or the aging process—and these disc problems are a common cause of chronic lower back pain.

Different types of surgery, including replacement of damaged discs, are options for patients with serious pain. However, in most cases, a conservative approach is best, according to the new review, published in the Journal of the American Academy of Orthopedic Surgeons.

About 90 percent of people with lower back pain can expect to recover within three months, even without treatment, say the researchers, and most will have some improvement within six weeks.

Moreover, there are still questions about the long-term effectiveness of surgery for disc-related back pain.

“Recently, disc replacement surgery has been proposed as a cure or treatment for symptomatic lumbar disc disease,” lead researcher Dr. Luke Madigan, of the Knoxville Orthopedic Clinic in Tennessee, said in a written statement.

However, he said, so far studies suggest the surgery is only about as effective as an older technique known as spinal fusion, in which the surgeon joins two or more vertebrae to help stabilize the problematic area of the spine. The success rate with that procedure has been between 50 percent and 60 percent.

The longer-term effectiveness of disc replacements is still unclear. “Long-term outcomes are still to be published and caution should be exercised with their use,” Madigan said.

On the other hand, studies suggest that physical therapy, including exercises to strengthen the abdominal muscles and education on how to lift objects safely—using the legs, not the back—often helps people with disc-related back pain.

Similarly, non-steroidal anti-inflammatory drugs, like ibuprofen and naproxen, often bring short-term pain relief.

“Surgery should be the last option,” Madigan said, “but too often patients think of surgery as a cure all and are eager to embark on it.”

For their part, he added, surgeons should carefully consider each patient’s situation and suggest surgery only to those who are “truly likely to benefit from it.”

SOURCE: Journal of the American Academy of Orthopedic Surgeons, February 2009.

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