Study recommends conservative management of lumbar disc herniation before surgical discectomy

A recent article appeared in the Spine Journal examines the cost of previous conservative care for patients that ultimately elect to have spinal surgery. The study consisted of 30,709 patients. The average cost of conservative care in the 90 days period before surgery was $3,445 each. Magnetic resonance imaging and other diagnostic procedures represented a little over half of the total pre-surgery costs. Of the treatment costs, 16% were for injections, 5.7% physical therapy, and 1.2% chiropractic care. Despite the fact that these expenses were for failed back conservative care, the authors recognize the overall benefits of conservative care and recognize that many patients are able to avoid surgery. They conclude that ¡§Although a large number of patients will ultimately require surgical intervention, given that many patients will improve with nonoperative therapy, a trial of conservative management is appropriate¡¨.

Previous studies have examined conservative versus surgical treatment related to several common causes of low back pain. For spinal stenosis, ¡§Among patients with lumbar spinal stenosis completing 8- to 10-year follow-up, low back pain relief, predominant symptom improvement, and satisfaction with the current state were similar in patients initially treated surgically or nonsurgically.¡¨ Another study of patients with disc herniation reported, ¡§¡Kwith moderate or severe sciatica, surgical treatment was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased over time.¡¨

Sources:
Daffner SD, Hymanson HJ, Wang JC. Cost and use of conservative management of lumbar disc herniation before surgical discectomy. Spine J. 2010 Mar 31.

http://www.chiroaccess.com/Articles/Studies-Recommend-Conservative-Care-for-Low-Back-Pain-before-Surgery.aspx?id=0000148

Dr. David P. Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic