Healthcare in the US at the moment is in shambles. Rising costs for insurance with less and less coverage. When it comes to our health and health strategies we are being more careful and critical of our options. So what happens when you are suffering with excruciating back pain and you are offered a replacement of a degenerated intervertebral lumbar disc? Do you simply go for it knowing that success is not guaranteed or look at research on other options that have had great outcomes at a much lower cost.
A Medically Noted Case Study
Previous studies have found rehabilitation programs to have efficacy roughly equal to lumbar fusion when chronic patients are randomized into treatment groups.(1-4) In a research study performed by Dr. Christian Hellum, an orthopedic surgeon from the Department of Orthopedics at Oslo University Hospital, and his colleagues attempted to compare the efficacy of a rehabilitation program to surgery with disc prosthesis.(5) Their results were published by the British Medical Journal.
The researchers randomized 173 patients into two treatment groups. The surgical intervention consisted of replacement of the degenerative intervertebral lumbar disc with an artificial disc – the ProDisc II Synthes Spine. Rehabilitation consisted of three to five weeks of physical workouts plus an emphasis on patient education (e.g. normal reactions to pain, coping strategies, family and social life, working conditions, physiology of the back, etc.). An interesting aspect of this study is that it only admitted patients who had already received physical therapy and or chiropractic care for at least six months without sufficient effect. Other studies have defined such patient groups as having “failed” conservative care. Participants all had low back pain for one year or more, an Oswestry disability index of 30 or greater, age 25-55, and disc degeneration.
The research group pre-defined a clinically significant difference as a treatment effect of 10 in the Oswestry disability index (where treatment effect was calculated as the difference between groups in mean change from baseline). At two-year follow-up, the researchers found the difference between rehabilitation and disc prosthesis surgery not clinically significant. The outcome concluded that the differences between the surgery and rehabilitation groups did not reach statistical significance: general health status, mental summary, fear avoidance belief questionnaire, emotional distress, drug consumption, and return to work.
Dr. Christian Hellum further concluded that even with this patient group, it is reasonable to consider rehabilitation. This group consisted of patients with chronic low back pain for more than a year, degenerative disc involvement, and having already received physical therapy for six months or more. He further pointed out the much lower cost of rehabilitation, the higher recuperation time and risk factors of surgical intervention. Surgeries in this study had an 8% complication rate and a 6.5% reoperation rate. Negative sequela of surgery included a lower leg amputation secondary to compartment syndrome, retrograde ejaculation, sensory loss, and radicular pain.
Understanding Your Options
If you are faced with this important decision remember that the decision is yours and to be aware that least invasive first maybe the key to the true path of recovery.
Our expert integrated team has been designed to offer the best recommendation and make available the full treatments with all of the consultants on site in a warm state-of-the-art environment which is located all under one roof. Call today. We are ready to help you explore your healthcare options.
References:
1. Brox JL, Sorensen R, Friis A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 2003; 28: 1913-21.
2. Brox JL, Reikeras O, Nygaard O, et al. Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain 2006; 133: 145-55.
3. Fairbank J, Frost H, Wilson-MacDonald J, et al. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 2005; 330: 1233.
4. Brox JL, Nygaard O, Holm I, Keller A, Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. Ann Rheum Dis 2009; 69: 1643-8.
5. Hellum C, Johnsen L, Storheim K, et al. Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study. BMJ 2011; 342d2786.
For Wellness,
Dr. Shannan McCormick