Is surgery better than exercises?

A study published this month (well a few months ago as I’m updating the blog) in the British Medical Journal looked at whether surgery with disc prosthesis (disc replacement) was more effective than rehabilitation. At 2 year follow up patients improved more after surgery than rehabilitation but both groups improved overall. However the improvement of surgery patients did not exceed the prespecified minimal clinically important difference. When you consider the additional risks involved in surgery this research supports the role of conservative care.

Chiropractors do apply manual therapy techniques with patients but a lot of what we do also includes both rehabilitation and advice to patients on how to manage their back pain and the rehabilitation methods in this study have a lot in common with a visit to see a chiropractor. In this study, patients in the rehabilitation group took part in a variety of physical exercises including training of the abdominal muscles and lumbar multifidi muscles. They also received training on the origins of back pain and were taught coping strategies for getting back to every day activities. In total they received about 60 hours of outpatient care over three to 5 weeks. There was significant improvement in the rehabilitation group without the risks of surgery! I believe surgery has its place in the management and treatment of back pain but this article is really important in reminding us clinicians to evaluate all the options.

http://www.bmj.com/content/342/bmj.d2786.full.pdf?sid=a871cd1a-1d90-4254-87a6-6164cd376323

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