12/14/2022
Interesting but not surprising results.
NEW PAPER AFFIRMS LIMITED ROLE FOR SURGERY IN SPINE CARE. Spinal surgery for all forms of back pain (other than for radicular pain and disability from neural compression, cancer, infection or gross instability) is unsupported by clinical data, and the broader evidence base for spinal surgery in the management of LBP is poor and largely ineffective, says a new study published in the Medical Journal of Australia.
Instead, the paper concludes, chronic low back pain should be managed with a holistic biopsychosocial approach of generally non‐surgical measures.
This narrative review focused on studies of any design involving adult patients (aged ≥ 18 years) with axial pain affecting the region of the lumbar spine. The focus was on patients experiencing axial LBP secondary to non‐specific degenerative changes such as facet arthropathy, disc degeneration and soft tissue abnormalities.
“The evidence supporting spinal surgery for the treatment of LBP in the absence of neural compression, infection, cancer, or gross instability is sparse and contrasts with the increasing frequency at which this surgery is being performed,” the study reports. It goes on to note significant bias from sponsoring industry and device manufacturers, where low quality and poorly-designed studies reach conflicting conclusions.
The study concludes: “Surgical intervention for LBP has increased substantially among Australian patients, and disproportionately among those with private health insurance. The contribution of industry toward this increase, and their role in the conduct of published research, requires further scrutiny.”
WFC Secretary-General Richard Brown commented, “Chiropractors can play an important and cost-effective role in the non-surgical management of many spine-related disorders. Hands-on care, such as spinal manipulation or adjustment, exercise prescription, lifestyle advice and education, and other rehabilitative approaches, can all contribute positively to patient outcomes.”
“The paper’s recommendation of a holistic, biopsychosocial approach to spine care is also a powerful endorsement for chiropractic’s inclusion in tackling the global burden of spine-related pain and disability.”
Reference: The role of spinal surgery in the treatment of low back pain
Lachlan Evans, Thomas O’Donohoe, Andrew Morokoff and Katharine Drummond
Med J Aust || doi: 10.5694/mja2.51788
Published online: 12 December 2022
Full text at https://www.mja.com.au/journal/2022/218/1/role-spinal-surgery-treatment-low-back-pain
