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South Nassau in the Community

02/20/2009

SPORT Proves Surgery is Effective Treatment for Lower Back Pain


A study published in Spine magazine found that patients who underwent surgery for lumbar disc herniation achieved greater improvement in all primary and secondary outcomes as compared to patients who received a regimen of non-operative treatment, including physical therapy and non-steroidal anti-inflammatory drugs.

“Perhaps the most important outcome of this study will be an increased trust and confidence in surgery as a safe and effective treatment to fix the condition that is causing the lower back pain,” said Michael Shapiro, MD, Chief of Orthopedic Spine Surgery at South Nassau Communities Hospital’s Center for Advanced Orthopedics. “After exhausting the array of non-surgical solutions to manage back pain and rehabilitate the cause of it, my colleagues and I use an array of patient-centered, minimally-invasive surgical approaches that are proven remedies for lower back pain.”

The study, Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation: Four-year Results for the Spine Patient Outcomes Research Trial (SPORT), assessed the four-year outcomes of 1,244 patients enrolled in random or observational groups and was conducted in 11 states at 13 medical centers with multidisciplinary spine health programs.

Patients enrolled in the observational group were given the choice of surgery or non-surgical treatment. Of the 743 “observational” patients, 521 chose surgery and 222 chose non-surgical treatment. Of the 501 patients enrolled in the random group, 245 were assigned surgery and 256 were assigned to non-surgical treatment.

A standardized treatment protocol was used for both the observational and random groups. The surgical treatment provided was standard open discectomy with examination of the involved nerve root. The non-surgical approach included physical therapy, home exercise instruction and non-steroidal anti-inflammatory drugs.

Patient outcomes were based on the Bodily Pain (BP) and Physical Function (PF) Scales of SF-36 Health Survey (a multi-purpose, short-form health survey that has proven useful in surveys of general and specific populations, comparing the relative burden of diseases, and in differentiating the health benefits produced by a wide range of different treatments) and American Academy of Orthopedic Surgeons’ version of the Oswestry Disability Index (the "gold standard" of low back functional outcome tools, which is used by researchers and disability evaluators use to measure a patient's permanent functional disability).

The study concluded that in the 4-year analysis those patients receiving surgery demonstrated significantly greater improvement in all the primary outcomes:

  • Body Pain decreased in 45.6 of surgical patients as compared to 30.7 of non-surgical patients;
  • 44.6 of surgical patients showed improvement in Physical Function versus 29.7 of non-surgical patients;
  • the ODI in surgical patients was -38.1 and -24.9 in non-surgical patients;
  • the percent working was similar between the surgery and non-operative groups, 84.4% versus 78.4% respectively.
Standard open discectomy is among the treatment options South Nassau Communities Hospital offers to alleviate back pain or correct back injuries. Its continuum of services for the back includes physical therapy, pain management and minimally invasive surgical interventions.

South Nassau's Sports Medicine & Rehabilitation Therapy (SMART) Center offers individualized programs of rehabilitation or therapy to treat the almost any back condition. Rehabilitation or therapy is based on a detailed assessment conducted by advanced diagnostic medical technology. Rehabilitative and therapeutic technology at the Center includes computerized stationary bicycles and treadmills, upper body ergonometers, Cybex® weight training equipment, ultrasound, electric simulation devices and sensory equipment.

South Nassau is one of the few hospitals on Long Island that provides a pain management program. South Nassau’s Pain Management Center provides traditional, complementary and alternative methods for treatment of acute and chronic back pain. The Center offers the latest treatments and technology in pain management and an experienced staff of specialists in pain management. Pain management services provided by the center include:
  • Nerve block, which consists of epidural steroid injections, radiofrequency, spinal pumps and spinal stimulation.
  • Radiofrequency Thermocoagulation Therapy (RFTC), a method where heat is applied to the outside of a nerve to interrupt the transmission of pain sensation from a spinal joint to the brain.
If a patient requires surgery, South Nassau’s team of orthopedic and neurologic spinal surgeons specialize in the most advanced minimally invasive spine surgeries that have proven to provide short- and long-term relief from debilitating, painful back problems. This includes:
  • Neurostimulation, a small implantable electrical device that generates a periodic electrical stimulation that alleviates the throbbing pain caused by chronic back pain conditions;
  • Lumbar Disc Replacement, which is prescribed for patients with one diseased disc and have failed six months of non-invasive treatment, such as pain medication or a back brace;
  • Kyphoplasty, a procedure that requires just two incisions less than three millimeters and is used to correct degenerative disc diseases such as vertebral compression fractures (which occur when the thick section of bone at the front of the vertebrae, which are the bones that make up the spine, fracture and collapse).
  • Approximately 95 percent of the patients to receive balloon Kyphoplasty report a complete recovery;
  • X STOP, a minimally invasive, ambulatory surgery to implant a device that alleviates the debilitating pain and symptoms of spinal stenosis. X STOP typically takes less than one hour and allows patients to walk out of the hospital the same day. In a two-year research study of X STOP, only 6% of patients in the study did not have a satisfactory treatment outcome;
  • Satellite, an emerging spinal surgical procedure that takes about 45 minutes to complete and involves implanting a small steel ball bearing that restores the normal spacing between damaged lumbar spinal discs.


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