April 28, 2014
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Speaker: Fusion to relieve low back pain proves controversial

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PHILADELPHIA — Fusion is a controversial method to relieve lower back pain when compared with more conservative treatment options, according to a presenter at the American Academy of Neurology Annual Meeting, here.

“Overall, limited evidence suggests that spinal fusion compared with physical therapy improves pain and function for adults undergoing fusion for low back pain due to disc degeneration,” John D. Bartleson, MD, FAAN, said. “The evidence was insufficient to draw evidence-based conclusions for the benefits and harms of spinal fusion for patients with degenerative stenosis.”

Among a handful of investigations into low back pain treatment that Bartleson, of the Mayo Clinic, in Rochester, Minn., cited, he discussed a study that involved 400 patients. Those researchers, he said, found that patients undergoing physical therapy that was new and different compared to their previous routines saw results in terms of back pain that were similar to those of patients undergoing fusion to treat low back pain due to spondylosis.

“All three of these studies showed no significant difference between the surgery group and a group not just left to their own devices, but a group with a new and different physical therapy program,” Bartleson said. “Here there was something active done in the nonoperative group, and in this case there was no improvement in the surgery group, but there was a 10% to 20% complication rate in surgery group,” he said.

When a physician decides not to do anything for patients with non-radicular back pain, Bartleson said fusion may be helpful, but he added that a new and better physical therapy might help the patient just as much as surgery.

“For non-radicular back pain with common degenerative changes, fusion is no more effective than intensive rehabilitation when associated with a small amount of benefits compared to standard non-surgical therapy,” he said. – by Robert Linnehan

Reference:

Bartleson JD. Session #C54. Presented at: American Academy of Neurology Annual Meeting; April 26-May 3, 2014; Philadelphia.

Disclosures: Bartleson has no relevant financial disclosures.