Medicine continues to make great strides against potentially lethal conditions such as cancer and heart disease. But some medical conditions that perplex doctors more than others, and potentially have a greater impact on society, are common, everyday debilitating conditions such as low back pain.
Low back pain, often caused by a wide variety of degenerative conditions, simply does not lend itself to one single “silver-bullet” cure. Complaints such as “my aching back,” certainly do not compare with a heart attack, do they? Prepare to be surprised: the annual economic cost for low back pain is estimated to be in the same ballpark as the economic cost of heart attacks.
“Unlike heart attacks, there is no standardized approach to low back issues,” says Dr. Michael Kaiser from The Spine Hospital at The Neurological Institute of New York. “For many patients, low back pain becomes a persistent problem and compromises the quality of their everyday life. It is not uncommon for patients to seek consultations from many different subspecialists and attempt numerous treatment options. Unfortunately, failure to achieve long-lasting pain relief and the ability to resume an active lifestyle are common results of such an uncoordinated approach.”
According to Dr. Kaiser, it is essential to coordinate the numerous treatments available to effectively localize the source of the patient’s pain as specifically as possible. This approach serves as the foundation for care provided by the spine specialists at The Spine Hospital. These specialists are nationally recognized leaders in the surgical care of spinal disorders, and they emphasize that surgery should always be considered as a last resort; when conservative treatments have failed.
The questions become: is surgery necessary?, and if so, which surgical alternatives are appropriate? One of the most common causes of disability from spinal disorders is a “slipped,” or herniated disc, and it is also one of the most common indications for spinal surgery.
A study, co-authored by Dr. Kaiser, examined this condition and one other, along with their respective surgical approaches. Patients enrolled in the study included those undergoing a microdiscectomy for a herniated, or “slipped” disc, as well as those undergoing a lumbar fusion for misalignment of the vertebrae, or spondylolisthesis. The objective of this investigation was to establish a data registry as a means to collect and evaluate patients’ responses to such treatments, and to assess their cost effectiveness.
“We found that both conditions were effectively treated by surgery, with significant improvements in patients’ quality of life identified at 30 days after the operation,” says Dr. Kaiser. “These improvements were maintained for at least one year following the operations, and over 80% of patients returned to their previous employment. Not only were the surgical results positive for individual patients, but also following a cost analysis, the benefits provided by surgery proved to be cost-effective to society.”
The authors say the study was strictly preliminary, however it did demonstrate the ability to successfully collect high-quality data in a real-world setting. Questions still remain regarding how to best manage chronic lumbar spine issues. “The results of the study did begin to lend credence to the observation that, for some patients, spinal surgery is the best alternative when other approaches have failed,” says Dr. Kaiser.
All patients with severe low back pain are encouraged to first talk with their primary care provider about their options. But when that is not enough, such patients should think about consulting with a qualified neurosurgeon.
Here is a full list of study authors: Mummaneni PV1, Whitmore RG, Curran JN, Ziewacz JE, Wadhwa R, Shaffrey CI, Asher AL, Heary RF, Cheng JS, Hurlbert RJ, Douglas AF, Smith JS, Malhotra NR, Dante SJ, Magge SN, Kaiser MG, Abbed KM, Resnick DK, Ghogawala Z
Post originally posted on Nov 27, 2014
Updated on July 5, 2017