NIAMS Says Surgery May Be Preferred Option for Some Back Problems
A study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases indicates that surgery may be the preferred option for some back conditions.
Akinso: Surgery versus conservative therapy: That's the choice that faces many people with a variety of common back problems. Now a study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases indicates that surgery may be the preferred option for some conditions. The study shows that for degenerative spondylolisthesis with spinal stenosis, surgery provides significantly better results than nonsurgical alternatives. Degenerative spondylolisthesis is a condition in which the breakdown of cartilage between the vertebrae of the spine causes one vertebra to slip over the one below, causing stenosis, or a narrowing of the canal through which spinal nerves pass. Dr. James N. Weinstein lead author of the study and Chairman of the Departments of Orthopaedics at Dartmouth-Hitchcock Medical Center and Dartmouth Medical School discusses the trial.
Weinstein: SPORT is the acronym we use which is Spine Patients Outcomes Research Trial. And the reason we did that is we wanted to look at several of the most common reasons for which patients have surgery in the United States. The study was designed to look at the three most common reasons for which patients have surgery in the United States and that's the herniated disk or where a disk is pressing on a nerve in your lower back. Spinal stenosis, imagine if you had your right hand grabbing your small middle and ring finger and squeezing them as tight as you could that's spinal stenosis of varying degrees. And then we looked at spinal stenosis with one vertebra slipping forward with the same kind of compression of the fingers but one of the bones in the back moving slightly forward on the other. The idea was to understand whether surgical or nonsurgical treatment would be better for patients with those 3 conditions.
Akinso: Dr. Weinstein said degenerative spondylolisthesis can result in narrowing of the spinal column, which can put pressure on the nerves, resulting in pain in the buttocks or legs with walking or standing. Dr. Weinstein added that it's important to give physicians and patients solid information about treatment.
Weinstein: I think the idea that we hope to provide through SPORT is the benefits of surgical versus nonsurgical treatment and to put that information into what I would like to call an informed choice format. Typically when a patient goes to their doctor, the doctor gives them a diagnosis. Iif they're going to recommend surgery, asking them to sign an informed consent. I think the informed consent process is rather outdated and arcane. And what we should be moving towards is an informed choice method, so patients who face a decision of one treatment versus another when the results might be equivalent or similar should be left in the patient's hand in consultation with their doctor. So the SPORT information provides significant information to patients about making a choice about surgical and nonsurgical treatment for these conditions.
Akinso: The study, published in the May 31st issue of the New England Journal of Medicine, is the second in a series reporting findings of SPORT. Dr. Weinstein said while it is generally not a good idea to rush into back surgery, the trial shows that there are conditions for which surgery clearly is the most effective treatment choice. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
About This Audio Report
Reporter: Wally Akinso
Sound Bite: Dr. James N. Weinstein
Topic: Back Problems