For patients with herniated discs in the lower (lumbar) spine, surgery leads to greater long-term improvement in pain, functioning, and disability compared to nonsurgical treatment, concludes an eight year follow-up study in Spine.
"Carefully selected patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operatively treated patients," according to lead author Dr. Jon D. Lurie of Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine and colleagues. The results add to the evidence for surgical treatment of herniated discs—but also show that nonsurgical treatment can provide lasting benefits for some patients. The study has been posted ahead of print on the journal website; it will be published in the January issue of Spine.
No Difference in Outcomes for Assigned Treatment…
The researchers analyzed data from the Spine Patient Outcomes Research Trial (SPORT), one of the largest clinical trials of surgery for spinal disorders. In SPORT, patients meeting strict criteria for herniated discs in the lumbar spine underwent surgery or nonsurgical treatment such as physical therapy, exercise, and pain-relieving medications. Patients with herniated discs experience back pain, leg pain (sciatica), and other symptoms caused by pressure on the spinal nerve roots.
The current analysis included eight-year follow-up data on 1,244 patients treated at 13 spine clinics across the United States. About 500 patients were randomly assigned to surgery (a procedure called discectomy) or nonsurgical treatment, although patients were allowed to "cross over" to the other treatment.
For the remaining patients, decisions as to surgery or nonsurgical treatment were left up to the patients and their doctors. Standard measures of pain, physical functioning, and disability were compared between groups.
Consistent with previous data from SPORT, patients assigned to surgery tended to have better outcomes. However, because many patients did not actually undergo their assigned treatment, the differences based on "intention to treat" were not statistically significant.
…But Better Outcomes with Surgery, Based on Actual Treatment
When outcomes were compared for patients who actually underwent surgery versus nonsurgical treatment, significant differences emerged. On a 100-point pain scale, pain scores averaged about 11 points lower in the surgery group. Measures of physical functioning and disability showed similar differences.
Surgery also led to greater improvement in some additional outcomes, including the bothersomeness of sciatica symptoms, patient satisfaction, and self-rated improvement.
While average outcome scores were better with surgery, many patients had significant improvement with nonsurgical treatment. After eight years, about one-third of patients who were clinically indicated for surgery have chosen not to have operative treatment.
SPORT Principal Investigator Dr. James N. Weinstein said this is significant and shows the important role that shared decision making plays in the process: "Every patient in the SPORT study went through shared decision-making, during which they reviewed objective information about the risks and benefits of their treatment options. This allowed them to make an informed choice, in line with their own values. That about a third of these patients have continued to be satisfied with their choice is in large part due, I believe, to their being active participants in the initial decision-making process" Weinstein said.
Lumbar disc surgery is one of the most commonly performed operations in the United States, although rates vary considerably in different regions. Past studies have suggested that surgery provides faster pain relief and recovery for patients with herniated discs, compared to nonsurgical treatment. However, it has been difficult to determine the true effects of surgery—especially because of the high number of patients who cross over from nonsurgical treatment to surgery. This tends to underestimate the true benefits of surgery.
The long-term follow-up results from SPORT show that, for patients with confirmed herniated lumbar discs, "[S]urgery was superior to non-operative treatment in relieving symptoms and improving function." Dr Lurie and coauthors note that the peak benefits are achieved within six months after surgery and persist through eight years.
However, many patients treated without surgery "also showed substantial improvements over time," the researchers write. They add that patients who crossed over to surgery were more likely to be dissatisfied with their symptoms, felt like their symptoms were getting worse, and had initially worse physical function and disability.
Explore further: Surgery found to be marginally better for discogenic pain
Medical Xpress on facebook
Related Stories
Surgery found to be marginally better for discogenic pain
Dec 14, 2013
(HealthDay)—Surgical patients demonstrate greater improvement at one year compared to patients utilizing nonsurgical treatment for discogenic pain, although success rates for either group are only fair, ...
Steroid injection may lead to worse outcomes in patients with spinal stenosis
Feb 19, 2013
For patients with spinal stenosis, epidural steroid injections (ESI) may actually lead to worse outcomes—whether or not the patient later undergoes surgery, according to a study in the February 15 issue of Spine.
Surgical treatment within six months of lumbar disc herniation
Oct 25, 2011
A new study in the Journal of Bone and Joint Surgery (JBJS) found that patients with herniated lumbar disc symptoms were significantly worse if the patients had symptoms for more than six months prior to treatment, compared to t ...
Evidence-based guidelines developed for disc herniation
Dec 26, 2013
(HealthDay)—Evidence-based clinical guidelines have been developed for management of lumbar disc herniation with radiculopathy; the guidelines have been published in the Jan. 1 issue of The Spine Journal.
Study finds poorer outcomes for obese patients treated for lumbar disc herniation
Jan 10, 2013
While obese patients are more likely to have surgical treatment for lumbar disc herniation – a slipped or ruptured disc – than nonobese patients, obesity increases operative time, blood loss and length of hospital stay, ...
Recommended for you
New study to revolutionise indications for knee surgery
4 minutes ago
Finnish researchers have shown that one of the most common surgical procedures in the Western world is unnecessary. Keyhole surgeries of the knee are useless for patients whose knee complaints are due to ...
Single-site hysterectomy procedure may reduce recuperation time, visible scars
8 hours ago
Hysterectomy, a surgery to remove the uterus, is done for a number of reasons, including cancer, irregular bleeding, fibroid tumors, prolapse (slippage) of the uterus and endometriosis.
Study questions value of common knee surgery
Dec 26, 2013
(HealthDay)—Improvements in knee pain following a common orthopedic procedure appear to be largely due to the placebo effect, a new Finnish study suggests.
Surgeons' group gives gift of new hips, knees to uninsured
Dec 25, 2013
(HealthDay)—Millions of Americans struggle daily with degenerative, painful and crippling knee or hip arthritis, or similar chronic conditions that can turn the simplest task into an ordeal.
Increase in consultations for Medicare patients before cataract surgery
Dec 23, 2013
Preoperative consultations before cataract surgery became more common for Medicare patients despite no clear guidelines about when to require such a service, hinting at unnecessary use of health care resources, according ...
Preop testing for low-risk cataract surgery patients: Choosing wisely or low-value care?
Dec 23, 2013
The elimination of extensive routine preoperative tests and consultations represents an area of potentially large health care savings across many disciplines, particularly for low-risk patients being evaluated for cataract ...
User comments
© Medical Xpress 2011-2013, Science X network
For patients with herniated discs in the lower (lumbar) spine, surgery leads to greater long-term improvement in pain, functioning, and disability compared to nonsurgical treatment, concludes an eight year follow-up study in Spine.
"Carefully selected patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operatively treated patients," according to lead author Dr. Jon D. Lurie of Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine and colleagues. The results add to the evidence for surgical treatment of herniated discs—but also show that nonsurgical treatment can provide lasting benefits for some patients. The study has been posted ahead of print on the journal website; it will be published in the January issue of Spine.
No Difference in Outcomes for Assigned Treatment…
The researchers analyzed data from the Spine Patient Outcomes Research Trial (SPORT), one of the largest clinical trials of surgery for spinal disorders. In SPORT, patients meeting strict criteria for herniated discs in the lumbar spine underwent surgery or nonsurgical treatment such as physical therapy, exercise, and pain-relieving medications. Patients with herniated discs experience back pain, leg pain (sciatica), and other symptoms caused by pressure on the spinal nerve roots.
The current analysis included eight-year follow-up data on 1,244 patients treated at 13 spine clinics across the United States. About 500 patients were randomly assigned to surgery (a procedure called discectomy) or nonsurgical treatment, although patients were allowed to "cross over" to the other treatment.
For the remaining patients, decisions as to surgery or nonsurgical treatment were left up to the patients and their doctors. Standard measures of pain, physical functioning, and disability were compared between groups.
Consistent with previous data from SPORT, patients assigned to surgery tended to have better outcomes. However, because many patients did not actually undergo their assigned treatment, the differences based on "intention to treat" were not statistically significant.
…But Better Outcomes with Surgery, Based on Actual Treatment
When outcomes were compared for patients who actually underwent surgery versus nonsurgical treatment, significant differences emerged. On a 100-point pain scale, pain scores averaged about 11 points lower in the surgery group. Measures of physical functioning and disability showed similar differences.
Surgery also led to greater improvement in some additional outcomes, including the bothersomeness of sciatica symptoms, patient satisfaction, and self-rated improvement.
While average outcome scores were better with surgery, many patients had significant improvement with nonsurgical treatment. After eight years, about one-third of patients who were clinically indicated for surgery have chosen not to have operative treatment.
SPORT Principal Investigator Dr. James N. Weinstein said this is significant and shows the important role that shared decision making plays in the process: "Every patient in the SPORT study went through shared decision-making, during which they reviewed objective information about the risks and benefits of their treatment options. This allowed them to make an informed choice, in line with their own values. That about a third of these patients have continued to be satisfied with their choice is in large part due, I believe, to their being active participants in the initial decision-making process" Weinstein said.
Lumbar disc surgery is one of the most commonly performed operations in the United States, although rates vary considerably in different regions. Past studies have suggested that surgery provides faster pain relief and recovery for patients with herniated discs, compared to nonsurgical treatment. However, it has been difficult to determine the true effects of surgery—especially because of the high number of patients who cross over from nonsurgical treatment to surgery. This tends to underestimate the true benefits of surgery.
The long-term follow-up results from SPORT show that, for patients with confirmed herniated lumbar discs, "[S]urgery was superior to non-operative treatment in relieving symptoms and improving function." Dr Lurie and coauthors note that the peak benefits are achieved within six months after surgery and persist through eight years.
However, many patients treated without surgery "also showed substantial improvements over time," the researchers write. They add that patients who crossed over to surgery were more likely to be dissatisfied with their symptoms, felt like their symptoms were getting worse, and had initially worse physical function and disability.
Explore further: Surgery found to be marginally better for discogenic pain
Medical Xpress on facebook
Related Stories
Surgery found to be marginally better for discogenic pain
Dec 14, 2013
(HealthDay)—Surgical patients demonstrate greater improvement at one year compared to patients utilizing nonsurgical treatment for discogenic pain, although success rates for either group are only fair, ...
Steroid injection may lead to worse outcomes in patients with spinal stenosis
Feb 19, 2013
For patients with spinal stenosis, epidural steroid injections (ESI) may actually lead to worse outcomes—whether or not the patient later undergoes surgery, according to a study in the February 15 issue of Spine.
Surgical treatment within six months of lumbar disc herniation
Oct 25, 2011
A new study in the Journal of Bone and Joint Surgery (JBJS) found that patients with herniated lumbar disc symptoms were significantly worse if the patients had symptoms for more than six months prior to treatment, compared to t ...
Evidence-based guidelines developed for disc herniation
Dec 26, 2013
(HealthDay)—Evidence-based clinical guidelines have been developed for management of lumbar disc herniation with radiculopathy; the guidelines have been published in the Jan. 1 issue of The Spine Journal.
Study finds poorer outcomes for obese patients treated for lumbar disc herniation
Jan 10, 2013
While obese patients are more likely to have surgical treatment for lumbar disc herniation – a slipped or ruptured disc – than nonobese patients, obesity increases operative time, blood loss and length of hospital stay, ...
Recommended for you
New study to revolutionise indications for knee surgery
4 minutes ago
Finnish researchers have shown that one of the most common surgical procedures in the Western world is unnecessary. Keyhole surgeries of the knee are useless for patients whose knee complaints are due to ...
Single-site hysterectomy procedure may reduce recuperation time, visible scars
8 hours ago
Hysterectomy, a surgery to remove the uterus, is done for a number of reasons, including cancer, irregular bleeding, fibroid tumors, prolapse (slippage) of the uterus and endometriosis.
Study questions value of common knee surgery
Dec 26, 2013
(HealthDay)—Improvements in knee pain following a common orthopedic procedure appear to be largely due to the placebo effect, a new Finnish study suggests.
Surgeons' group gives gift of new hips, knees to uninsured
Dec 25, 2013
(HealthDay)—Millions of Americans struggle daily with degenerative, painful and crippling knee or hip arthritis, or similar chronic conditions that can turn the simplest task into an ordeal.
Increase in consultations for Medicare patients before cataract surgery
Dec 23, 2013
Preoperative consultations before cataract surgery became more common for Medicare patients despite no clear guidelines about when to require such a service, hinting at unnecessary use of health care resources, according ...
Preop testing for low-risk cataract surgery patients: Choosing wisely or low-value care?
Dec 23, 2013
The elimination of extensive routine preoperative tests and consultations represents an area of potentially large health care savings across many disciplines, particularly for low-risk patients being evaluated for cataract ...
User comments
© Medical Xpress 2011-2013, Science X network
0 comments:
Post a Comment