Surgery For Low Back Pain: Review Of Evidence

Surgery For Low Back Pain: Review Of Evidence

Amarillo chiropractor gives you the information you need

Why They Did It

The researchers wanted to update their understanding of the benefits, as well as the harmful effects, of surgery in the cases of non-radiating (no pain into the leg) back pain as well as surgery in patients with common degeneration, radiating pain (pain into the leg) due to a herniated disc. They also wanted to update the understanding on surgery for pain that was due to stenosis of the spine. Spinal surgery is very common these days but it’s still unclear as far as when, where, and why it’s being done. 

How They Did It·     

• The researchers used databases called Ovid MEDLINE and Cochrane to search the research abstracts having to do with their study. They took randomized controlled trials and reviews.·     
• They used 2 independent reviewers.·     
• They followed specific rules and guidelines in their review of the literature. 

What They Found·     

• In Non-Radicular low back pain with degeneration, there was fair evidence showing vertebrae fusion to be no better than intensive rehab but slightly to moderately better than standard nonsurgical therapy without intense rehab.·     
• In Radiating pain from a herniated disc, there was good evidence that discectomy (surgery) was moderately better than nonsurgical treatment through 2-3 months after the operation. I think it’s important to note that it is not clear, in fact it’s doubtful, as to whether the researchers considered or compared conservative spinal decompression recovery and success rates to those of surgery. ·     
• Let us keep that in mind before we accept that the surgery was “moderately better than nonsurgical treatment.” In our experience here in my office, that would only be true in a handful of cases out of several hundred. They’re just not looking at ALL of the information in this paper.·     
• They also found that benefits with surgery often decreased over the long-term when followed up on. 

Wrap It Up

Surgery for radiating pain from a herniated disc and/or spinal stenosis that is actively hurting is associated with short-term benefits when compared to nonsurgical therapy. Although, as noted above, they aren’t including ALL nonsurgical therapies when making this opinion. Most notably the safer and non-invasive treatments like traction, mobilization, manipulation, etc. 

For non-radiating back pain in the case of degeneration, fusion surgery is no more effective than intensive rehab.

 - Chou R, Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline.Spine, 2009. 34(10): p. 1094-109.