What is the efficacy of less-invasive surgical treatments for low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

A less invasive alternative to decompression laminectomy is interspinous distraction. These studies are minimally invasive but can be difficult in the older population. Bony elements that support distraction of the spinous processes into a fix-flexed posture may be osteoporotic. This procedure has been associated with a greater pain relief than nonoperative therapy. The data from long-term studies are lacking. Conclusions that resulted from analysis of system reviews and the SPORT studies suggest that physical therapy referral might be the first best clinical prescription. The patients should be taught how to modify activities to avoid lumbar extension and taught exercises that strengthen the abdominal muscles. Some may require corsets placed in a slight flexion. Adjunctive medication therapies are optional and should be treated as a medical decision between the patient and the physician. [270, 271]

If more invasive therapies are considered or if psychosocial or economical factors require more rapid recovery, then the consideration of surgical therapy is warranted. Depending on the patient’s age and expectations of fusion in addition to decompression, it is probably more effective at 4-10 years. In evaluating the surgical treatment of spinal stenosis with and without degenerative spondylosis using a 2-year timer horizon and as-treated analysis, the economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions. Degenerative spondylosis surgery is not highly cost effective over 2 years but may show a value of a longer time horizon. Again, the most important factor and outcome efficacy may be the patient’s needs and desire, and their conviction as to the appropriate method of treatment when fully informed by the treating physician.

A 2012 Cochrane Review showed no clinical important differences between disc replacement and conventional fusion surgery for degenerative disc disease in measures of short-term pain relief, disability or quality of life. [272]


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