From the Desk of Dr. Karl R.O.S. Johnson, DC.....

A study* published in the February 15, 2011 issue of Spine, shows that spinal fusion surgery in patients with chronic low back pain leads to worse long-term outcomes – including a lower rate of return to work – compared to non-surgical treatment.

In this study the researchers compared 725 lumbar fusion cases to 725 randomly selected controls selected from a pool of workers’ compensation patients with chronic low back pain who underwent non-surgical conservative treatment such as physical therapy, exercises, etc. Final treatment outcomes included return to work, disability, and use of strong pain medications at two years follow-up.

In nearly all outcome categories it was worse for patients who had spinal fusion surgery. Only 26% of the spinal fusion patients returned to work after 2 years compared to 76%of those under conservative treatment. Also, 27% of patients in the surgical group had repeat surgery while 36% experienced some type of complication.

Eleven percent of the surgical patients had permanent disability, compared to 2% of the non-surgical patients. Most spinal fusion patients continued using opioid drugs after surgery with many taking higher doses. There were also more deaths in the spinal fusion group. The average days off work was greater for the surgical group compared to the non-surgical group (1,140 days off vs. 316 days off).

At a time of continued controversy over the role of spinal fusion surgery and the fact that this procedure has increased exponentially over the last decade despite lack of evidence that it improves patient outcomes, the results of this study raises questions about the long-term effectiveness of spinal fusion surgery.

Lead researcher Trang H. Nguyen, MD who practices occupational medicine in Cincinnati, Ohio, and his co-researchers write, “This [spinal fusion surgery] is offered to improve pain and function, yet objective outcomes showed increased permanent disability, poor return to work status, and higher doses of opioids.” They also note the lack of evidence supporting the use of spinal fusion for degenerative disc disease, herniated discs, of radiculopathy – the diagnoses present in most of the workers in the study. Their conclusion is that spinal fusion should be “cautiously considered” in workers’ compensation patients and then only for patients with diagnoses for which spinal fusion has proven specifically effective.

*Nuyen T, Randolph DC, Talmage J, et al. Long-term Outcomes of Lumbar Fusion Among Workers’ Compensation Sunjects: A Historical Cohort Study. Spine Feb 15, 2011; 36(4):320-331

The use of a patient-centered multi-disciplinary Spine Care Pathway (SCP) helped to minimize lower back pain (LBP) and the associated treatment costs, according to a recent study, “A Hospital-Based Standardized Spine Care Pathway: Report of a Multidisciplinary, Evidence-Based Process,” published in the Journal of Manipulative and Physiological Therapeutics, February 2011, Vol. 34, No. 2.

Using the National Center for Quality Assurance (NCQA) Back Pain Recognition Program (BPRP) as its framework, the SCP provided patients with the five care options cited as the most effective in the back pain literature: spinal manipulation, extension and flexion directional preference exercises, core stabilization exercises, and mechanical traction.

“Lower back pain is a common condition affecting an estimated 90 percent of the population at some time,” said Ian C. Paskowski, D.C., lead author and medical director, Medical Back Pain Program at Jordan Hospital, Plymouth, Mass., the site from which this study’s date was derived. “Current methods of relieving LBP are often uncoordinated, inefficient and expensive. However, our team of researchers was the first to implement an evidence-based, standardized SCP, which aligned individual patients with the appropriate conservative care option. As predicted, the results were improved patient health and satisfaction rates, with decreased costs.”

The LBP program at Jordan Hospital, managed chiefly by Doctors of Chiropractic, treated 518 patients in the first six months of the program, using a two-tiered clinical management approach. Of the total patient population, 402 were exclusively cared for by D.C.s who achieved successful treatment outcomes in an average of just 5.2 visits at the extremely low cost of only $302 per case, while maintaining a patient satisfaction rate above 95 percent. Self-reported pain and disability scores were reduced by about 70% over the course of just a few weeks.

Primary Care Physicians (PCPs) have traditionally been the providers to initially see LBP patients. “We have demonstrated that when this spine care pathway is offered to PCPs, they will utilize these evidence-based guidelines and chiropractic services,” said Paskowski. “I largely credit our Doctors of Chiropractic for achieving these excellent clinical outcomes and attaining such high patient satisfaction rates. Their dedication to individual patient needs and a patient-centered approach aligns flawlessly with the medical home model and yields remarkable results. We anticipate that this SCP will become the globalized framework for uniformity and consistency in healthcare for LBP management, and that chiropractors will become the non-surgical spine care experts in the health care system.”

Often times patients with severe back pain or certain conditions, such as when bones are weakened or have swelling and inflammation of the joints or even muscle strain, it is nearly impossible to perform high impact exercises. Since maintaining good health, muscle structure and flexibility is crucial to preventing further issues, it is imperative that patients find activities they can perform safely.  Read the articles below and follow the links to the full article for more information on low impact exercises for back pain relief.