Back to Normal: Surgery Improves Outcomes for Spine Patients

New study finds patients who opt for surgery have decreased pain, increased
function

ROSEMONT, Ill., June 1 /PRNewswire-USNewswire/ -- 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.

JBJS
AAOS
http://www6.aaos.org/news/pemr/releases/release_boiler.cfm?category=1&releasenum=783

SOURCE American Academy of Orthopaedic Surgeons

Kristina Findlay of the American Academy of Orthopaedic Surgeons,
+1-847-384-4034, findlay@aaos.org