Treating Spine and Back Conditions

Three new studies presented at the 77th Annual Meeting of theAmerican Academy of Orthopaedic Surgeons (AAOS) detail advances in back care and treatment options for specific spine and back conditions. Results of the studies, AAOS officials said, can help surgeons and patients decide together when surgery is appropriate.

The studies focused on three serious spine and back conditions: herniated discs, injury and deterioration of the vertebrae.

Herniated Discs: When to Seek Treatment?
According to the AAOS, lumbar disc herniation (commonly known as slipped discs) mainly affects adults aged 30 to 40 years old.The condition is usually caused by degenerative changes in the spine, with symptoms beginning gradually in the lower back and then progressing to the buttocks and down the legs. The pain from this condition can be extreme.

A study released Wednesday analyzed the effect of the length of symptoms in treating herniated discs in the lower back. The study compared 927 patients who had intervertebral lumbar disc herniation symptoms for less than six months and 265 patients who had symptoms longer than six months. Patients with symptoms that lasted longer than six months had worse outcomes after both surgery and non-operative treatments than patients with symptoms that lasted less than six months, the study concluded.

“The bottom line is patients who seek treatment, whether it is surgical or non-surgical, during the first six months of symptoms will respond better to treatment,”said Jeffrey A. Rihn, M.D., study co-investigator and assistant professor with the Department of Orthopaedic Surgery at Thomas Jefferson University Hospital and The Rothman Institute, both inPhiladelphia, Pa. “We also learned that surgery offers advantages over non-surgical treatment regardless of the duration of symptoms.”

Learn more about this study.

Spine Injury: Is Surgery the Best Option?
Lumbar spinal stenosis is the leading cause of spine surgery in patients over the age of 65, according to AAOS. Previous studies have shown the benefit of surgery compared with non-surgical treatment of this condition. But these studies did not specify the indications for surgery and the candidates that selected surgery.

A study unveiled at the meeting analyzed 241 patients who underwent surgery and 115 who opted for non-operative care. Researchers concluded that patients who chose surgery were usually younger, experienced more pain and disabilities, and believed their symptoms were progressing.

“These results help complete the evaluation and treatment algorithm for patients with spinal stenosis. The findings will enhance the shared decision-making process by aiding physicians in counseling patients to help them choose the right treatment option,” explained Mark F. Kurd, M.D., lead author of the study and orthopaedic surgery resident at Thomas Jefferson University Hospital and The Rothman Institute.

Learn more about this study.

Vetebral Fractures: Surgical or Non-Surgical Care?
Vertebral compression factures are one of the most common consequences of osteoporosis, according to the AAOS. Current non-surgical treatment options include pain medication, bed rest, physiotherapy and back bracing. These options, however, do not prevent the breakdown of the vertebrae, which can result in height loss and other problems.

Balloon kyphoplasty is a minimally invasive procedure for actue vetebral fractures that reduces and corrects the vertebral deformity by inserting expandable balloon tamps and filling it with bone cement. In 2007, 46,000 inpatient kyphoplasty procedures were performed in the United States, according to the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project coordinated by the Agency for Healthcare Research & Quality.

The AAOS released results from a study of 149 patients treated with balloon kyphoplasty and 151 patients treated with non-surgical treatment. The study measured patients’ quality of life, back pain and function, and days of disability for two years. Compared to non-surgical care, balloon kyphoplasty improved patients’ quality of life, reduced their back pain and disability, and did not increase the risk of subsequent vertebral fractures.

“I have been using balloon kyphoplasty to treat patients with painful vertebral compression fractures for years so the immediate and sustained pain relief we saw in the study did not surprise me,” concluded Jan Van Meirhaeghe, M.D., study co-author and orthopaedic surgeon, Department of Orthopaedic Surgery, St-Jans Hospital, Brugge, Belgium and Gent University Hospital, Gent, Belgium. “But until now these decreased pain levels and significant quality of life improvement, as compared to non-surgical treatment, had not been demonstrated in a clinical trial.”

Learn more about this study.