Rehab as Good as Back Surgery

[drusso]

From CNN:


Study: Rehab as good as back surgery

Article Link

Monday, May 23, 2005 Posted: 10:25 AM EDT (1425 GMT)


LONDON (Reuters) -- Surgery to relieve chronic lower back pain is no better than intensive rehabilitation and nearly twice as expensive, researchers said on Monday.

Low back pain is one of the world's most common complaints.

Researchers at the Nuffield Orthopaedic Centre in Oxford, England found little difference when they compared the effects of surgery with rehabilitation on nearly 350 sufferers.

"This is strong evidence that intensive rehabilitation is a good thing to do for people with chronic back pain who are thinking of having about having operations," said Jeremy Fairbank, an orthopaedic surgeon at the centre.

"The ultimate outcome ... is there is not much difference," he told Reuters.

Fairbank and his colleagues studied 349 back pain sufferers who either had spinal fusion surgery or intensive rehabilitation involving exercises and cognitive behavioural therapy.

Thirty patients in the therapy group later had surgery.

The researchers, whose findings are reported online by the British Medical Journal, concluded that there was no evidence that surgery was any better.

But the average cost for a surgery patient was 7,830 pounds ($14,400), compared to 4,526 pounds for rehabilitation.

"In the short term, compared with intensive rehabilitation, surgical stabilisation of the spine as first line treatment for chronic low back pain patients who have already failed standard non-operative care seems not to be cost effective," said Helen Campbell of the University of Oxford in the journal.

Doctors suspect chronic back pain is caused by a combination of normal wear and tear on the joints of the back and poor muscle control. It is treated with physiotherapy, osteopathy, chiropody and surgery or a combination of treatments.

"The peak prevalence is in young middle age," said Fairbank.

He added that surgeons offering spinal fusion surgery, in which one or more vertebrae of the spine are joined to stabilise a section of the spine, should explain all the options to patients.

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[DigableCat]

Link to the BMJ article....It's on the front page. BMJ.COM


Much like the ortho docs weren't happy with the guy from Baylor and his article about knee arthroscopy, something tells me that many spine surgeons will be quick to attempt to dismiss this article as well.

Fortunately(or unfortunately depending on how you look at it), the insurance companies will get wind of this pretty fast. They may put more emphasis(read: not reimburse) on rehabilitation before surgery. But then you have to deal with patients who legitimately need surgery but insurance companies wont allow them until they've gone through a course of "standard rehab" which could be different for each company. And as we know, this increases the chances that the inciting pain generator, may no longer be the chronic pain generator...and hence the patient becomes more difficult to treat.

Overall though, I'm just glad a major journal and major news source has picked up on this...many patients never realize that surgery is only one option. Some patients come to me, and the first thing out of their mouths is to tell me what their MRI shows, not their symptoms. And they look at me rather skeptical, when I tell them that their symptoms could very easily be self limited, and we shouldn't rush to surgery.