Chronic backache is undoubtedly one of the most
debilitataing of all illnesses and its cure has been controversial. Surgery is not
panacea for all backaches is well known and intensive rehabilitation has its limitations too and not all patients are
able to follow the regime.
Researchers in a recent study have concluded that for chronic low back
pain, spinal fusion surgery is NOT better than intensive rehabilitation in
relieving discomfort. The conclusions though seem a little biased against
surgery and are a little round about - read this report and decide for
Back problems are among the commonest reason to
consult a doctor and over the past several years has had the distinction of
being the leading cause of work-loss. In fact almost 83
million days of work are lost per year due to backache
. An estimate
shows that 65 million Americans report a recent episode of
back pain and 16 million adults i.e almost 8 percent of adults suffer from persistent
or chronic back pain. The direct
and indirect cost in United States from this problem is estimated to be over
$12 billion per year.
To alleviate this chronic
and nagging pain, depending upon the cause, there are usually two options - surgery
In a randomized multicenter study in Norway,
investigators compared the efficacy of surgery with disc prosthesis versus
non-surgical treatment i.e rehabilitation for patients with chronic low back pain.
In a two-year follow-up of
randomized study, 173 patients (86 with
surgery and 87 with rehabilitation) were
included and treated between April 2004 and September 2007. Surgery with disc prosthesis or outpatient
rehabilitation for 12-15 days was carried out.
Post study results indicate that spinal surgery was more
effective than an adequate rehabilitation program for chronic low back pain. However
the cost analysis also found that surgery to be much more expensive for patient
Lead author, Christian Hellum from Norway reported
that "Although surgical
intervention with disc prosthesis for chronic low back pain resulted in a
significantly greater improvement as compared with rehabilitation, but this
improvement did not clearly indicate surgery as a clear cut winner as the
potential risks of surgery always remains there". Hence, the finding seems to indicate that surgery though may have a slight advantage,
but the benefit is still remains too small,
considering the potential inherited surgical risk
for the procedure and financial expense of surgery.
Deriding the results of the surgery
the authors concluded the study by stating, "Surgery for chronic low back pain is no better than intensive
rehabilitation and is quite unlikely to be considered a cost-effective use of
scarce healthcare resources."
Druss, Marcus, S., Olfson, M., and Pincus, H.A. (2002). "The Most Expensive
Medical Conditions in America." Health Affairs
, 21(4): 105-111.
2. Surgery with disc
prosthesis versus rehabilitation in patients with low back pain and
degenerative disc: two year follow-up of randomised study; Christian Hellum et
al;BMJ 2011; 342:d2786.