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 months2 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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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.