Originally posted by aric_taylor2000
Disc's can easily be fixed. It takes about 4-6 months to fully recover.
This is an overly optimistic statement.
The conventional teaching suggests that those most likely to benefit from surgery are patients with dermatomal symptoms, positive objective findings on physical examination (e.g., crossed straight-leg raising), and a pain level that is severe, rather than mild to moderate. A confirmatory imaging study is a prerequisite.
Surgeons perform 300,000 laminectomies and 70,000 spinal fusions per year and the numbers on the rise. Lumbar Spine Surgery Nervous System Complications are 12 per 1000 and Lumbar Spine Surgery Death are 3 per 1000.
Currently, about 15% of patients undergoing initial low back operations will fail to achieve relief from surgery helping to generate a significant number of revision spine surgeries each year. Only 50% of patients will find relief with their second revision surgery. This is due to Failed Back Surgery Syndrome (FBSS).
Another facet of this debate is whether surgery is necessary for chronic back pain patients in the first place.
A Norwegian study has shown that patients with chronic lower back pain get as much benefit from behavioural therapy as they do from spinal fusion surgery.
The study aimed to rigorously test the surgical technique, where vertebrae are pinned together in an effort to reduce pain. Although it is not well understood why the operation only works for some people, it is increasingly popular in some places, said Dr. Jens Ivar Brox, from the National Hospital in Oslo.
"In California for example, the number of back fusions was 15,000 in 1995 and in 1999 was 21,000," Brox said. "At the same time the price for each operation increased from $35,000 to $46,000."
All the patients in the study had back pain that had lasted for more than a year, and had evidence of disc degeneration. The behavioural therapy involved identifying the patient's thought and behaviour patterns about their pain, and helping them overcome them, including specific exercises.
In the study, Brox and his colleagues randomly assigned 64 patients to either cognitive behavioural therapy or surgery and followed their level of disability for the following year. He presented his results here at the Annual European Congress of Rheumatology.
"According to an independent observer, the success rate was 70 percent after surgery and 76 percent after cognitive intervention and exercise," Brox said.
"We had expected that surgery would be better than the non-surgical treatment," he told reporters at the conference. "But the outcome was similar."
"This difference between the two groups was not (statistically) significant," the researcher said. "However, this study shows clearly that simple cognitive intervention can be both physically- and cost-effective in patients with chronic low back pain."
He said his group was conducting a followup study, and hoped that other groups would conduct similar research to see if they achieved similar results.
