KNOXVILLE, Tennessee—Low back pain (LBP) nearly always resolves without surgery, usually within 6 weeks, according to a review article that will be published in the February 2009 issue of The Journal of the American Academy of Orthopaedic Surgeons.¹ The analysis also recommends core-strengthening physical therapy, NSAIDs, and activity rather than bed rest.

”Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it. Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it,” said lead author Luke Madigan, MD. Dr. Madigan is attending physician at Knoxville Orthopaedic Clinic in Knoxville, Tennessee.

The reviewers concluded that:

• 90% of patients with low back pain will have symptoms resolve without surgery, within 3 months
• Most low back pain patients will recover within 6 weeks
• Intradiscal electrothermal treatment (IDET) is no better than sham treatment of LBP
• Arthrodesis “remains a controversial form of treatment of discogenic back pain”
• The jury is still out on the usefulness of total disc replacement and motion sparing technology in discogenic low back pain

“The vast majority of patients with low back pain will have resolution of their symptoms without surgical
interventions, with physical therapy and non-steroidal anti-inflammatory drugs being the cornerstone of treatment,” the authors wrote.

Dr. Madigan commented, “Recently, disc replacement surgery has been proposed as a cure or treatment for symptomatic lumbar disc disease, but the FDA studies on lumbar disc replacement have only so far shown equivalence to fusion for discogenic disease. Long-term outcomes are still to be published, and caution should be exercised with their use.” Dr. Madigan also noted that the success rate for surgical fusion has been 50-60%.

Translating research into practice: What works in low back pain?

Dr. Madigan and colleagues recommend beginning low back pain treatment with physical therapy that focuses on strengthening core muscle groups in the abdominal wall and lower back, NSAIDs, and educating patients about better body mechanics.

“With this type of natural history, the initial treatment of all patients with low back pain, without a neurologic emergency, should be nonsurgical,” Dr. Madigan said.

Reference

1. Madigan L, Vaccaro A, Spector LR, Milam A. The management of symptomatic lumbar degenerative disk disease. JAAOS 2009 [in press].