For Patients with Common Back Ailments, Surgery is the Way to Go

WNBC—NEW YORK, N.Y.—May 30, 2007

Sufferers of back pain may find quicker relief thanks to a study published in the May 31 issue of The New England Journal of Medicine. Doctors found that surgery gave substantially better results than nonsurgical therapy for one of the most common back conditions for which patients seek treatment.

“I couldn’t go for a walk,” said Dolores Sanchione, a resident of Stratford, Conn., and former synchronized swimmer. “General, everyday things were difficult.”

Ms. Sanchione suffered from degenerative spondylolisthesis with spinal stenosis, which affects six times as many women as men. “Degenerative spondylolisthesis is caused by the slippage of one vertebral body forward on another,” explained Dr. Frank P. Cammisa, Jr., chief of the spine service at Hospital for Special Surgery in Manhattan, who also sees  patients at the hospital’s Greenwich, Conn., practice office.

“A herniated disc, more commonly known as a slipped disc, and spinal stenosis – when the spinal canal narrows and puts pressure on the nerves of the spinal cord – are the other two conditions that require the consideration of surgery,” said Dr. Cammisa, who is a collaborating author on the study.

The slippage itself generally causes no symptoms, but, as in Ms. Sanchione’s case, it can lead to spinal stenosis, causing significant pain in the legs and making it difficult to walk.

Although back surgeries are among the most common surgical procedures performed in the United States, there had been only a few very small controlled trials to gauge their effectiveness. This study, called the Spine Patient Outcomes Research Trial (SPORT), a seven-year, $21 million national study funded by the National Institutes of Health, is one of the first to directly compare the effectiveness of surgical and nonsurgical options.

Following 601 patients over two years, including Ms. Sanchione, Dr. Cammisa and his colleagues around the country found that surgery was twice as effective as nonsurgical approaches.

“As the patients were treated, we saw a significant benefit for surgery over nonsurgical care in terms of relief of pain, return to function – basically their quality of life,” said Dr. Cammisa.

Two years after enrollment in the trial, patients who had received only nonsurgical therapy, including physical therapy, steroid injections and medicines, reported only modest improvement in their condition. However, patients who had surgery to relieve the pressure on the nerves reported significantly reduced pain and improved functionality, with major improvements as early as six weeks after their operation.

Though the study was designed to be randomized, 40 percent of participants who had been randomized changed their minds after enrollment and switched to the other group—either choosing to have surgery after being randomly placed in the non-operative group, or vice versa. As a result of the substantial crossover, the authors chose to publish the results based on what treatment was actually received. So, while this is not a randomized comparison, the doctor’s carefully controlled for differences that existed between the two groups in their analysis.

Ms. Sanchione, who had been part of a women’s synchronized swimming team for 35 years, is now able to swim recreationally and enjoy walks with her husband. “Going to Dr. Cammisa and having the surgery changed my life,” she said.

Make sure to talk to your doctor and explore all options. "Receiving the right diagnosis," said Dr. Cammisa, "is the most important step."

Watch an interview with Dr. Camissa and his patients who participated in the trial as well as an interview with Dr. Gregory Lutz, chief of Physiatry at HSS, on WNBC-TV.

About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked as No. 2 in orthopedics, No. 3 in rheumatology and as among the best in geriatrics and neurology by U.S. News & World Report, and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In the 2006 edition of HealthGrades' Hospital Quality in America Study, HSS received five-star ratings for clinical excellence in its specialties. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Medical College of Cornell University, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Medical College of Cornell University. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at http://www.hss.edu/

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