Two Studies Find Advantage of Back Surgery Over Conservative Treatment

Back problems improve more rapidly after surgery than with conservative treatment, two studies in the New England Journal of Medicine find.
In one study, 283 patients with sciatica underwent randomization either to early surgery or to conservative treatment using surgery only if needed. At 1-year follow-up, there were no significant differences between the groups in pain, disability, and recovery scores, but the early-surgery group experienced quicker pain relief and a faster rate of self-perceived recovery.
The other study involved some 600 patients with degenerative spondylolisthesis, one cohort of which underwent randomization to either decompressive laminectomy or usual nonsurgical care, and the other cohort of which chose their treatment with their physicians. As-treated analysis of the whole population (there was much crossover between treatments) revealed an advantage for surgical care both in pain relief and functional improvement; the difference persisted over 2 years. There was no such advantage found under intention-to-treat analysis.
The author of a commentary says that "caution is in order" for the second study, given the differences between the analyses. He concludes that "absent major neurologic deficits, patients with herniated disks, degenerative spondylolisthesis, or spinal stenosis do not need surgery, but the appropriate surgical procedures may provide valuable pain relief."