Surgery is Best for Spinal Stenosis
Reported May 31, 2007
ORLANDO, Fla. (Ivanhoe Newswire) — Surgery is the best option for the millions of patients who suffer from a very common back condition called spinal stenosis, according to a new study.
Degenerative spondylolisthesis with spinal stenosis is a condition that affects six times as many women as men and is especially prevalent among African-American women, for unknown reasons. In reducing pain and restoring functionality for patients, surgery was found to be twice as effective as non-surgical approaches.
Alan S. Hilibrand, M.D., a researcher on this study, told Ivanhoe, “There was this disagreement about whether operations help some of these common lumbar spine problems, and this is the first attempt at a very large group of patients treated, specializing in treatment of spine problems, to compare surgical vs. non-surgical treatments to see whether one was superior to the other.” Although back surgery is a very common procedure performed in the United States, there were only a few small controlled trials to gauge their effectiveness until this study.
Degenerative spondylolisthesis (DS) happens when one lumbar vertebra slips forward onto the one below it and generally occurs after age 50. Although DS alone generally causes no symptoms, it can result in spinal stenosis in some cases, which is when the spinal canal narrows, causing pressure to the nerves. Spinal stenosis can result in significant pain in the legs that can be worsened by simply walking.
In this study, 372 patients with DS and symptomatic spinal stenosis received surgery, while 235 patients remained non-operative, meaning they received treatments including physical therapy, steroid injections and medicines to relieve pain. The surgery, called a decompressive laminectomy, involves removing bone and soft tissue in order to relieve pressure on the nerves. “It’s a major operation. It involves decompressing the spinal canal and in most cases, also performing a fusion,” Dr. Hilibrand says.
Two years after enrollment in the trial, non-operative patients reported only modest improvement in their condition, whereas the patients who had surgery reported significantly reduced pain and functionality. Dr. Hilibrand says it is important to compare these results with previous results of disk herniation surgery. According to Dr. Hilibrand, in disk herniation studies, people who were treated both surgically and non-surgically improved. The surgical group did slightly better, but both groups still saw significant improvement. “Here, people who didn’t have surgery didn’t get better,” Dr. Hilibrand says. “For this problem, for patients to get better, in general, they really needed the operation, and you see that in the dramatic differences when you look at how people did based upon exactly how they were treated.”
SOURCE: Ivanhoe interview with Alan S. Hilibrand, M.D.; The New England Journal of Medicine, 2007;356:2257-70
