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Surgery Best for Narrowing of Spine
Date:2/20/2008

Study says it beat nonsurgical care for painful condition that often accompanies aging

WEDNESDAY, Feb. 20 (HealthDay News) -- The largest study of its kind concludes that surgery is better than nonsurgical treatments for spinal stenosis, a painful narrowing of the spine that stems from the normal deterioration that accompanies aging.

People who underwent an operation showed more improvement in pain, function, satisfaction and self-rated progress than those who received the typical, nonsurgical care.

But the procedure should not be overused, warned the authors of the study, which is published in the Feb. 21 issue of the New England Journal of Medicine.

"We don't want people to surmise that because this works, all spine surgery is good," said study author Dr. James Weinstein, chairman of the department of orthopedics at Dartmouth Medical School, in Lebanon, N.H. "These people all had very specific physical findings and diagnostic criteria. In these specific cases, this is a good operation. This is not a back pain operation."

Although surgery to correct the condition is common, particularly among those over the age of 65, Weinstein noted there was little objective evidence on the effectiveness of such a procedure.

"Studies have not been done in a way that might be generalizable or usable for the rest of country," Weinstein said.

The study involved two groups of patients: 289 who were randomized to receive surgery or usual nonsurgical care (physical therapy, education or counseling with home exercise instruction, and non-steroidal anti-inflammatory drugs if indicated), and 365 who did not want to be randomized and so were assigned to an "observational" group. In all, 13 clinics in 11 states were involved.

All participants had had at least 12 weeks of symptoms of spinal stenosis, without spondyloisthesis (when a vertebra in the lower part of the spine slips), as confirmed
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