A group of Dartmouth researchers published the first scientific evidence linking a specific surgery with relief of lower back pain caused by spinal stenosis. The study was published in the New England Journal of Medicine on Feb. 21.
"[The results] give us solid information with which to inform our patients. Up until now, our information has been anecdotal, based on our own experiences with patients we've treated," said James Weinstein, the leader of the study and director of the Dartmouth Institute for Health Policy and Clinical Practice. Weinstein is also the chair of the orthopedics department at Dartmouth Medical School and Dartmouth-Hitchcock Medical Center.
Spinal stenosis is a medical condition typified by the narrowing of the spinal canal, which pressurizes nerves going to the legs and causes back and leg pain. The condition is the most common cause of lower spinal surgery in adults over age 65, according to Weinstein.
A total of 400 subjects in the study underwent the surgery, while 254 subjects opted for alternative methods of relief.
All patients had experienced symptoms for at least 12 weeks prior to the study, had been diagnosed with spinal stenosis and were eligible for surgery.
"As a nation, we spend $24 billion on back surgery annually. It's important for us as physicians, our patients, and the healthcare system overall, to know that what we are doing is the right and most effective thing to do." Weinstein said.
The results of the study showed that non-surgical treatments improved conditions in patients but surgery was significantly more effective in reducing back pain.
"This study confirms that the surgical procedures we have been doing are effective. But it also tells us that indeed patients have a choice," Weinstein said. "Thirty-eight percent of the patients in this trial have not had surgery and they continue to proceed with their lives."
Weinstein, a spinal surgeon, stressed that there is still no right or wrong decision in dealing with spinal stenosis. He said he was surprised at the extent to which patients who did not undergo surgery were able to function with the condition.
The spinal stenosis study is the third phase of a larger study known as the Spine Patient Outcomes Research Trial, which studied three lower back conditions -- invertebral disc herniation, degenerative spondylolisthesis, and spinal stenosis -- which are the most common causes for spinal surgery.
The SPORT study was primarily funded by the National Institutes of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes, according to the Dartmouth Medical School website.
Along with Weinstein, the SPORT study was co-authored by Tors Tosteson, Jon Lurie, Anna Tosteson, Emily Blood and Brett Hanscom, all of DHMC and DMS, in addition to a number of other physicians.
