Landmark Journal Article Results in Back Pain Medicine

At least for me, the most interesting published articles in journals of Back Medicine are those that compare the results of one back pain treatment to another. These article results are important because it is the best chance for all of us to get unbiased information about which back pain treatments work best. Here's why. If you were to try going to 5 different back pain specialists, you would be likely to get five different types of opinions as to how to treat your symptoms. An orthopedist would be likely to recommend surgery. An chiropractor may recommend manual spinal manipulation. An osteopath might recommend spinal manipulation plus holistic therapies such as acupuncture. A spinal surgeon may be likely to recommend surgery. Each back specialist may be biased towards one type of treatment based on the training they had and their own clinical experience. How do we know which treatment is most likely to work best? How do we get a straight answer. Here are some landmark journal results in back pain medicine.



One of the great questions of the modern age of back pain medicine concerns the long term results of surgical interventions vs. conservative treatments such as physical therapy. How do patient who have undergone surgery such as spinal fusion do in the short term and long term compared to those who have done simple exercises at home and at their local gym? Also, will the success outcomes depend on the specific causes of the patient's symptoms as well as their levels of pain preceding their respective types of treatment? Here's a look at the Article "Surgery versus Prolonged Conservative Treatment for Sciatica", published on May 31, 2007 in the New England Journal of Medicine. This article compared two groups of back pain suffering subjects: one group of patients who were treated with microdiskectomy procedures following prolonged conservative treatment for sciatica, and one group who had microdiskectomy surgery following much shorter trials of conservative treatment for sciatica. A total of 283 patients were divided into the two groups. The dependant variables among the two groups were a decrease in symptoms within one year of surgery, and the decrease in symptoms after 1 year of having the surgery. There was no significant overall difference in patient self-ratings of symptoms during the first year, though patients assigned to early surgery reported a faster rate of perceived recovery. In both sets of patients, the probability of perceived recovery after one year of follow-up was 95%. What conclusions can we make of this study. First, the study included only 283 patients, so we may want to take that low subject number with a grain of salt. One may conclude that both early and later surgical interventions for sciatica are appropriate, given the overall 95% success rate. Personally, I would have liked to have seen a third group that had prolonged conservative treatment for sciatica, with no surgical intervention at all, all the way up until the end of the study. Also, I would have loved the study to have had a forth patient group that had no intervention at all. Would the two non-surgical groups have also had high success outcomes?