According to a study led by Dr. Adam Pearson of Dartmouth Medical School, Lebanon, N.H, in the January 15, issue of Spine, married patients undergoing surgery for herniated spinal discs whose symptoms are getting worse see greater improvements following the procedure than patients who received nonoperative treatments.
Even though all patient subgroups typically have better outcomes with surgery than nonoperative treatment, results from the investigation may provide a better insight into the relative advantages surgery for herniated discs has in individual patients compared to nonsurgical treatment.
The team examined data from the Spine Outcomes Research Trial (SPORT) - one of the largest human trials of surgery for spinal disorders. SPORT participants were randomly assigned to receive either nonsurgical treatment or surgery.
The investigation revealed a "clear benefit" of surgery for herniated discs over 4 years. Although, the discoveries at the group level did not take into account a variety of factors, such as clinical, radiographic (x-ray), demographic, and psychological characteristics - that can affect the way individuals respond to therapy.
The team compared outcomes for subgroups of patients defined by 37 different variables in order to find out which patients benefited most from surgery. The researchers focused on the "treatment effect" of surgery - how much patients improved with surgery compared to the improvement with nonsurgical treatment.
Dr. Pearson and his team explain:
"All analyzed subgroups improved more with surgery than with nonoperative treatment." The team point out that several various characteristics appears to influence how much individuals improved with surgery, such as education, having a worker's compensation claim, marital status, and duration of symptoms.
The researchers found three factors that were independently associated to improved treatment effect of disc surgery: married patients, those without other joint problems (knee, hip, etc), as well as those whose back pain symptoms worsened at the time of treatment.
Married patients with worsening symptoms saw the greatest improvement from surgery. The treatment effect of surgery in this subgroup was approximately 18 points on a 100 disability rating scale: a 38-point improvement with surgery compared with a 20-point improvement with nonsurgical treatment. For single patients with stable symptoms the treatment effect was approximately 8 points: 35 points with surgery in comparison with 27 points with nonsurgical treatment.
Although, researchers are unsure why marital status affects response to surgery, investigations have demonstrated improved outcomes for a wide variety of health problems among married patients. The team was not surprised by the effect of worsening symptoms, as these individuals were already getting worse without surgery. In addition, patients without other joint problems may have better general health.
According to Dr. Pearson and his team, results from this study may help patients and doctors foresee the advantages of herniated disc surgery in individual patients.
The researchers stress that all patients should undergo:
"...a thorough shared decision making process educating them about the risks, benefits and likely outcomes of surgical and nonoperative treatment."
"Real time computer models" may be created in the future in order to compare the likely outcomes of surgery compared with nonoperative treatment, based on patient characteristics.
Written by Grace Rattue