Spinescope

Abstract

The clinical entity known as discogenic back pain remains controversial. Four randomized trials have attempted to compare efficacy of surgical and nonsurgical treatment with one trial showing improved results with surgery and the others showing comparable results. Mirza et al. performed a prospective observational cohort study to compare the outcomes of community-based surgical and nonsurgical treatments for patients with chronic back pain attributed to degeneration at one or two lumbar discs. Patients presenting with axial back pain to academic and private practice orthopaedic surgeons and neurosurgeons in a large metropolitan area were included. Patients receiving spine surgery within 6 months of enrollment were designated at the surgical treatment group and the remainder as nonsurgical treatment. Outcomes were assessed at intervals up to 1 year after enrollment. Overall, 495 patients with discogenic back pain presented to 16 surgeon offices. A total of 86 patients (17%) had surgery within 6 months of enrollment. Surgery typically consisted of instrumented fusion (79%), disc replacement (12%), and laminectomy or discectomy (9%). Surgical patients who reported more severe pain and physical disability at baseline were more likely to have had prior surgery. Adjusting for baseline differences in groups, surgery showed a limited benefit over nonsurgical treatment of 5.4 points on the modified 23-point Roland disability questionnaire. On the basis of these data, the authors conclude that the surgical group showed greater improvement at 1 year compared with the nonsurgical group, although the composite success rate for both treatment groups was only fair. The results should be interpreted cautiously because outcomes were only short term, and the treatment groups were not randomly assigned. Some studies have showed early advantages of surgery, which tend to be less pronounced with longer follow-up. Mirza SK, Deyo RA, Heagerty PJ, Turner JA, Martin BI, Comstock BA. Spine J 2013;13:1421–1433.