Surgery for Chronic Spine Pain: Procedures for Patient Selection and Outcome Enhancement
Andrew R. Block The WellBeing Group
Craig Callewart Baylor University Medical Center
Pain arising from the spine is most often successfully treated using a nonoperative approach. Most individuals experiencing back pain can recover with 2 to 3 days of bed rest and anti-inflammatory medication ( Deyo, Diehl, & Rosenthan, 1986). Even those patients who experience protracted pain rarely undergo invasive treatment. Although approximately 70% of individuals in the United States experience back pain at some point in their lives ( Fordyce, Brockway, & Spengler, 1986), only about 70% of back pain sufferers have medical conditions requiring surgery ( Spitzer, 1987). Yet the number of spine surgeries performed in the United States is still quite large. Approximately 280,000 surgeries for low back pain are performed yearly ( Taylor, Deyo, Cherkin, & Kreuter, 1994). Thus, spine surgery is a not infrequent approach when nonoperative measures have failed to produce relief.
Unfortunately, the outcome of spine surgery is far from uniform. For example, Turner et al. ( 1992) reviewed 47 studies examining the outcome of lumbar spinal fusions. They found that, on average, 68% had satisfactory results, although satisfactory outcome ranged from 16% to 95%. The outcome for the somewhat simpler and less invasive procedure of laminectomy/discectomy is a little better. Hoffman, Wheeler, and Deyo ( 1993) reviewed the results of 81 published studies on discectomy and concluded that about 75% of patients receive short-term relief of sciatica (leg pain), with a 10% reoperation rate.
Despite such inconsistent results, spine surgery does offer the promise of pain relief and improved lifestyle for certain patients with unremitting