For Spinal Stenosis, Surgery Works Well
Surgery is a valid choice for people who suffer back and leg pain caused by two common ailments in older people, spinal stenosis and spondylolisthesis, according to a study in the May 31 New England Journal of Medicine.
About 1.2 million people a year have spinal stenosis, in which arthritis narrows the spinal canal and pinches nerve roots. Many of them also have slipped vertebrae, called spondylolisthesis. The problems are most common in people in their 60s and older and are caused by normal aging. Researchers at 13 medical centers in 11 states signed up 607 patients. Half were randomly assigned for surgery–usually spinal fusion and laminectomy, which removes bone and tissue compressing nerves. The other half were offered conservative treatment including pain medication such as ibuprofen and physical therapy.
The patients who underwent surgery had significantly less pain and better physical function than those who did not, from three months after surgery until two years later. Leg pain eased more quickly and more fully than did back pain, suggesting that pain caused by compressed nerve roots is more amenable to surgery. "It surprised me," says James Weinstein, an orthopedic surgeon at Dartmouth Medical Center who led the study. "I thought the nonoperative patients would do better." He was also surprised that many people decided not to have the surgery, despite their pain.
Spinal fusion is major surgery, requiring a bone graft from elsewhere on the body, and has a higher complication rate than simpler surgery, such as that for herniated disks. In this study, many of the patients assigned for surgery decided to forgo it, and others assigned to the no-surgery group decided to have an operation, making the results of the study less clear than if it had been fully randomized.
"It looks like spinal fusion really makes a difference," says Richard Deyo, a professor of medicine at the University of Washington and Harborview Medical Center, who wrote a commentary on the study for the New England Journal. "But what it doesn't say is what happens in five or 10 years. This is not a permanent cure." The researchers plan to follow the study participants for 10 years to see if they need further surgery.
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