Nov. 4, 1999 (Atlanta) -- Most people experience low back pain at one time or another. In fact, Kansas University Medical Center researchers estimate 75% of all people will experience back pain at some time in their lives. Back pain is the second leading cause of absenteeism from work, after the common cold, and accounts for 15% of sick leaves. Only 25% of injured workers will ever return to work if their disabling back injury has kept them from their job for more than one year. "Lower back pain is a complex entity, and its proper surgical management and the surgical decision making is complex and poorly understood," Gar Wynne, MD, at the San Francisco Orthopaedic Medical Group, tells WebMD.
A new study from Sweden shows the majority of patients whose doctors recommend major back surgery show improvement. The study appeared in the Oct. 1 issue of the journal Spine. Carl Leufvén, MD, of the Department of Orthopedics, Maelarsjukhuset Eskilstuna, in Gothenburg, Sweden, studied 29 patients two years after they underwent spinal fusion surgery. At that time, they had a removal of a herniated disc in their back along with a fusion of the two vertebrae on either side of the disc. The fused vertebrae are joined together by bone. This fusion adds strength to the vertebral column while allowing adequate space for nerves to travel.
In the study, patients chosen for surgery all had a history of chronic low back pain for more than two years and missed work for more than six months (average, 3.4 years). Bone fusion was successful in 93% of the patients, where back and leg pain was significantly reduced. Of the 29 patients, the results were judged excellent in nine patients, good in six patients, fair in six patients, and poor in eight patients. A total of 18 patients -- more than 60% -- had returned to work. The authors conclude that fusion can be a safe and effective method for dealing with some forms of chronic lower back pain.
Not so fast, says Wynne, who was not involved in the study. "Why, with a 93% 'proven' fusion rate, why were only 31% rated excellent?" Wynne tells WebMD. "And why was there only a return-to-work rate of 61%? Perhaps more could be learned from studying the 47% of patients with solid fusions and fair and poor results."
The good news is the vast majority of back-injured patients, probably greater than 90%, will recover completely without surgical treatment. But for those for whom surgery is recommended, there's the fear that the surgery won't relieve their pain. According to Leufvén's study, over half will experience excellent or good results.