Research done at Beaumont Hospital, Royal Oak, along with twelve other sites nationwide, recently published in the New England Journal of Medicine found back surgery for spinal stenosis and a slipped vertebra proved to have better results than nonsurgical remedies.
The paper is the second in a series detailing the findings of the Spine Patient Outcomes Research Trial, a 7-year, $21 million, study funded by the National Institutes of Health. Beaumont was the only Michigan hospital to participate in the trial.
"The SPORT study is not only unique because of its large size, but because it provides both doctors and patients important information when deciding how to treat back pain," says Harry Herkowitz, M.D., co-author of the article and chief of orthopedic surgery, Beaumont, Royal Oak. "Until this study, there had been only a few very small controlled trials to gauge the effectiveness of back surgeries."
In cases of degenerative spondylolisthesis with spinal stenosis, a condition that affects six times as many women as men, especially prevalent among black women, surgery was twice as effective as nonsurgical approaches in reducing pain and restoring functionality.
Degenerative spondylolisthesis, also known as DS, is the forward slippage of one lumbar vertebra on the one below it. It generally occurs after age 50. Although DS alone generally causes no symptoms, in some cases it can result in spinal stenosis - the narrowing of the spinal canal which causes pressure on the nerves. This results in significant pain in the legs that is worsened by simply taking a walk.
SPORT followed 601 patients diagnosed with DS and symptomatic spinal stenosis. Of those, 372 received surgery within two years and 235 remained nonoperative. Two years after enrollment in the trial, while nonoperative patients reported only modest improvement in their condition, patients who had surgery reported significantly reduced pain and improved functionality. Surgical patients saw relief from symptoms fairly quickly, reporting major improvements as early as 6 weeks after their operation.
Nonoperative treatments included physical therapy, steroid injections, and medicines to relieve pain. Surgery involved relieving pressure on the nerves through removal of bone and soft tissue in a procedure called a decompressive laminectomy.
This publication follows the release of earlier SPORT findings in November, which looked at patients seeking treatment for disk herniation with sciatica. For that condition, the difference between outcomes between the surgical and nonoperative groups was less.
The third major SPORT study, on the effectiveness of surgery vs. nonsurgical options for spinal stenosis without any spondylolisthesis, is expected to be released later this year.