Spine Surgery Yields Greater Benefits Compared With Nonsurgical Treatments

NEW YORK -- March 7, 2008 -- Patients who undergo surgery for spinal stenosis show significantly more improvement in all primary outcomes compared with patients who are not surgically treated. The study results, published in a recent issue of the New England Journal of Medicine, come from the Spine Patient Outcomes Research Trial, which was sponsored by the National Institutes of Health.

The researchers enrolled surgical candidates who had a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis to a randomised cohort (n = 289) or an observational cohort (n = 365) at 13 US spine clinics. The participants received decompressive surgery or their usual nonsurgical care.

The primary outcomes measured were bodily pain and physical function on the Medical Outcomes Study 36-item Short-Form General Health Survey and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, 1 year, and 2 years.

At 2 years, the researchers found that 67% of patients who were randomly assigned to surgery had undergone surgery, and 43% of those who were randomly assigned to receive nonsurgical care had also undergone surgery. Moreover, 63% of those who had surgery said they had a major improvement in their condition compared with only 29% among those who had received nonsurgical treatment.

With regard to self-reported pain and function, both study groups noted improvement during the 2-year period; however, the final scores for patients who had surgery were in the 60-point range. Scores for participants who received nonsurgical treatments, such as physical therapy, were in the low 40s.

An as-treated analysis, which combined the results of both cohorts and was adjusted for potential confounders, showed that there was a significant advantage for surgery by 3 months for all primary outcomes, and the authors noted that these changes remained significant at 2 years.


SOURCE: New England Journal of Medicine, February 21, 2008