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Avoiding
Surgery for Low Back Pain
Newswise — The simplest method for treating
low back pain may actually be the best
method. A literature study published in the
February 2009 issue of
The Journal of the American Academy of
Orthopaedic Surgeons finds that in most
cases of symptomatic lumbar degenerative
disk disease, a common cause of low back
pain, the most effective treatment is simply
a combination of physical therapy and
anti-inflammatory medication.
Symptomatic lumbar degenerative disc disease
occurs when a disc weakens, often due to the
effects of aging, repetitive strain or
injury to the disc space. The result is that
the disc cannot hold the vertebrae as well
as it used to, and that lack of stability
can cause low back pain.
In some cases, the pain is great enough that
the patient may seek treatment from an
orthopaedic surgeon. These treatments can
include a range of noninvasive and
invasive/surgical options.
According to the review findings:
1 90 percent of patients with low back pain
will see their symptoms fade on their own
within three months
2 Most of those patients will recover within
six weeks.
Therefore, the researchers determined that,
barring an emergency, the initial treatment
of all patients with low back pain should be
noninvasive.
“Recently, disc replacement surgery has been
proposed as a cure or treatment for
symptomatic lumbar disc disease,” says Luke
Madigan, M.D., an attending physician at
Knoxville Orthopaedic Clinic, Knoxville, TN,
and the lead author of the review. “But the
FDA studies on lumbar disc replacement have
only so far shown equivalence to fusion for
discogenic disease. Long-term outcomes are
still to be published and caution should be
exercised with their use.” Madigan also
notes that in the past, surgical fusion was
used to treat this condition, and the
success rate was 50-60 percent.
Meanwhile, noninvasive treatments have
brought about greater success by helping
patients strengthen the injured area and
prevent further strain:
1 Physical therapy that focuses on
strengthening core muscle groups in the
abdominal area and the lower back has
demonstrated positive effects in patients
with disc-related pain.
2 Non-steroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen and naproxen have been
found effective for short-term relief of low
back pain, and no NSAID was found to be any
more effective than the others.
3 Educating patients on better body
mechanics—for example, lifting with the legs
instead of the back—is found to lessen the
strain that is placed on the lumbar region.
4 Another recent literature review advocated
mobilization or activity in the treatment of
low back pain as opposed to bed rest, and
exercise has been shown to improve function
and decrease pain in adult patients with
chronic low back pain.
5 Braces have not been found to be effective
in treating low back pain, although whether
patients actually wear the brace in the
prescribed manner may be a factor.
Invasive treatment should only be explored
if these and other noninvasive treatments
have not been effective.
“Surgery should be the last option, but too
often patients think of surgery as a cure
all and are eager to embark on it,” Madigan
says. “Also, surgeons should pay close
attention to the list of contraindications,
and recommend surgery only for those
patients who are truly likely to benefit
from it.”
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