Research and Clinical Trials

Effectiveness of Sciatica Treatment, Herniated Disc Surgeries Compared in Recent Study

cmaynard — Wed, 15 Jul 2009 09:27:47 -0700

July 15, 2009
by: Sylvia Marten

Examining the effectiveness of conventional microdiscectomy and tubular disectomy surgeries for treatment of [url:996,type=|node|,content=|sciatica symptoms|] resulting from a [url:885,type=|node|,content=|herniated disc|], a recent study found and opined that the minimally invasive, tubular surgery did not result in better outcomes for patients despite such claims in the past.

[url:1584,type=|node|,content=|conventional microdiscectomy|]. The most commonly performed surgery for patients with sciatic leg pain from disc herniation, [url:5991,type=|node|,content=|microdiscectomy|] (also known as lumbar decompression surgery) entails the removal of a small portion of the bone over the nerve root and/or disc material under the nerve root to relieve neural impingement and provide more room to heal.
[url:6025,type=|node|,content=|tubular discectomy|]. Introduced in 1997, tubular discectomy involves a similar procedure to the one described above, with the exception that it is performed through a tubular device. This type of herniated disc surgery has been described as producing less tissue damage and resulting in a faster rate of recovery, the latter point serving as the basis of examination for the Sciatica Micro-Endoscopic Discectomy trial.

Performed by researchers in the Netherlands, this trial involved 328 patients (ages 18 to 70 years) who:

had persistent leg pain from lumbar herniated discs for more than 8 weeks
were hospitalized in 7 general hospitals in the Netherlands from January 2005 to October 2006
were randomized to either a tubular discectomy (approximately 167 patients) or conventional microdiscectomy (161 patients).

A blind follow up was conducted a year later, with functional ability, pain and a self-view of recovery assessed via a series of questionnaires and surveys.

Findings on Microdiscectomy and Tubular Discectomy

According to the study, conventional microdiscectomy produced more favorable results than tubular discectomy after one year for:

functionality. The mean score on the Roland-Morris Disability Questionnaire (RDQ), which has a 0-23 score range with higher scores indicative of worse functional status, was 3.4 for conventional microdiscectomy and 4.7 for tubular discectomy.
leg pain. On the visual analog scale, the 1-year mean difference was in favor of conventional microdiscectomy (with scores of 4.2 mm for leg pain and 3.5 mm for [url:145,type=|term|,content=|back pain|]).
self-reports of recovery. 120 of 151 patients (79%) who had conventional microdiscectomy reported good recovery a year later while 107 of 156 of patients (69%) who had tubular discectomy reported good recovery a year after the minimally-invasive procedure.

It should be known that this randomized control trial by no means knocks the validity of tubular disectomy as a minimally-invasive procedure for herniated discs; rather, it challenges certain claims like it increasing the rates of recovery.

Source: JAMA

More on This Topic

[url:1001,type=|node|,content=|Sciatic Nerve Anatomy and Sciatica Symptoms|]
[url:1016,type=|node|,content=|The Truth about Sciatica|]
[url:715,type=|node|,content=|Lumbar Herniated Disc|]
[url:884,type=|node|,content=|Treatment Options for a Lumbar Herniated Disc|]
[url:9574,type=|node|,content=|Surgery Options for a Herniated Disc|]
[url:18207,type=|node|,content=|Lower Back Pain after Surgery|]
[url:7996,type=|node|,content=|Sciatica Treatments|]

FDA Approves Third Cervical Artificial Disc: the Bryan Cervical Disc from Medtronic

mlepore — Wed, 03 Jun 2009 08:00:17 -0700

June 4, 2009
by: Spine-health Staff Writer

After long trials of deliberation, Medtronic’s Bryan Cervical Disc became FDA-approved on May 12, 2009. The Bryan Cervical Disc, designed to alleviate [url:149,type=|term|,content=|neck pain|] and related disability caused by degenerative disc disease, had received a favorable FDA recommendation back in July of 2007.

Although approved, conditions have been put in place for the approval of the Bryan for the next ten years. Medtronic will be conducting a post-market study, which will include tracking of patients' neck disability index scores, radiographic information, neurological status and a number of other outcomes in addition to data on adverse events and explanted devices.

What is unique about the Bryan is it is designed to better mimic natural disc shock absorption. It is made of titanium and polyurethane, which is softer than the nuclei of competitive discs, such as the Prestige’s metal on metal design. The polyurethane in the Bryan raised questions on wear debris during the FDA panel, but was determined to not be an issue for short-term use. Long-term use is an area of concern though, and will be under surveillance.

The Bryan (Medtronic), Prestige (Medtronic) and ProDisc-C (Synthes) are the only cervical [url:164,type=|term|,content=|artificial disc replacement|] options for the U.S., although there are expected to be more approvals and launches soon. At this point, Medtronic has not commented on the Bryan’s approval, or on projected launch dates when it will be commercially available.

Posted by: Spine-health Staff Writer

Additional Artificial Disc Replacement sources:

[url:1379,type=|node|]
[url:1380,type=|node|]
[url:1388,type=|node|]
FDA approves Medtronic’s Bryan Cervical Disc

Surgical Errors: Should You Re-think Surgery?

Fri, 01 May 2009 08:26:07 -0700

May 1, 2009
by: Stephanie

The decision to undergo surgery can be difficult to make, as it involves placing your life into someone else's hands. Patients want to trust their doctors, but in a recent survey of 917 members of the American Academy of Orthopaedic Surgeons (AAOS) and NASS initiative, more than half reported observing surgical errors within the past six months.

The most commonly reported errors related to problems with equipment, comprising 29% of incidents. Often, it was the instrumentation that was reported to cause error, about twice as often as implants (63% compared to 32%). Errors related to implants usually involved a missing or wrong implant.

Communication errors made up 25% of the responses, involving written, verbal or dictated information or failure to communicate altogether. 33% of these errors resulted in negative outcomes to the patient (delayed surgery, etc.) while 47% resulted in no harm to the patient.

Twenty-seven reports were of wrong-site surgery; 59% were wrong side. Other problems included the correct side but wrong location, wrong procedure or rarely, a wrong patient.

The most serious errors reported involved medication, occurring in eight patients. Of these eight patients, two errors resulted in death, four patients required life-sustaining intervention and two patients sustained permanent harm.

This study proves that doctors can make errors and the AAOS has developed programs to decrease the frequency of such errors. For example, the Sign Your Site program encourages surgeons to initial the procedure site to help reduce the incidence of wrong-site surgeries. The program also encourages doctors to call a “time out” prior to making the incision to double check equipment, records, allergies to medications, etc.

Although the study showed that about half of all errors do not result in harm to the patient, it also demonstrated that there is need for improvement. Relatively simple measures can be taken to greatly improve patient safety in the operating room.

If you are considering surgery realize that there are steps you can take with your doctor to insure that none of these surgical errors occur when you are under the knife. We published these statistics as a means of informing our readers because the more informed you are the better questions you will ask and the more successful your surgery will be.

Posted by: Stephanie

More Resources:

[url:1543,type=|node|,content=|Failed Back Surgery|]
[url:1796,type=|node|,content=|Spine Fusion Risks and Complications|]
[url:8355,type=|node|,content=|Spine Surgery Risks, Complications, and Success Rate|]
[url:1869,type=|node|,content=|TLIF Back Surgery Success Rates|]

Original Surgical Errors Article Health Point Capital.

Is Your Pain Medication Prescribed Off-Label?

Mon, 01 Oct 2007 14:46:35 -0700

October 1, 2007
by: Sylvia Marten

Experts estimate that 21% of prescriptions for common drugs are written for off-label uses. According to a study on Off-Label Prescribing published in the Archives of Internal Medicine, three-fourths of those prescriptions were for off-label uses that lacked scientific support. What's going on?

First, let's talk about what we mean by on "label" drugs. In the U. S. , the FDA requires that drug makers submit, test and get approval from the FDA for specific uses of their product before the product can ever be marketed. To obtain approval, pharmaceutical manufacturers must submit extensive study data demonstrating safety and effectiveness, a process which usually takes several years and millions of dollars. When a product is approved by the FDA, a specific "label" for that product is approved too. The label must include the product's approved indications, dosage and method of administration, and use in specific populations.

So, what is "off-label"? After the FDA approves a drug for its specific use, physicians can prescribe the product for uses not covered by the approved label. This is "off-label" use. Off-label uses include:a drug prescribed to patients with conditions not listed on the approved label; departure from the approved drug dosage, method of administration, or patient population; and unapproved product combinations, such as using two different drugs to treat a single condition. This practice is perfectly legal but it lacks any kind of oversight.

"Off-label" drugs for back pain. Among the types of drugs commonly prescribed off-label, most common were heart drugs and anti-convulsants (indicated for seizures). For example, gabapentin, brand name Neurontin, had one of the highest proportions of off-label use among specific medications, namely for neuropathic pain (it is only indicated for use in controlling epileptic seizures and in pain from post-herpetic neuralgia). Neurontin also happens to be a quite commonly prescribed drug for people diagnosed with chronic back pain or chronic low back pain. This of course means the drug is being prescribed off-label in the back pain patient population.

Patients should always consider carefully all medications that are prescribed to them. It is fair for patients to ask their doctors whether a prescription is on or off-label, and this can be easily and more thoroughly researched on reliable health information websites that address medications, such as MedlinePlus, the FDA, or condition-specific sites. If off-label, it is important to know whether there is sufficient data to support its use or if the practitioner's decision is based on anecdotal evidence. The patient should weigh off-label recommendations against the alternatives with his/her practitioner, and ultimately decide if he/she is comfortable with an off-label drug for the specific health issue being addressed. It is important for patients to keep in mind that a drug prescribed off-label to them is a drug that has not been approved by the FDA for some element of their specific health situation.

Is "off-label" drug prescribing good or bad? There isn't a clear cut answer. Anecdotally, many of my colleagues and personal circle of friends have experienced off-label drug use with positive results. For example, our children have been prescribed albuterol for various severe pulmonary episodes (not asthma, for which it's indicated) with much success. The Spine-health.com message boards are full of stories of people taking medications off-label for back pain or [url:887,type=|node|,content=|leg pain|] as prescribed by their doctors, with many experiencing much needed pain relief not possible with approved drugs. So, off-label use can be positive in that it expands access to important health benefits that may not be possible with alternatives. On the flip side, concerns and warning bells should go off with respect to safety and the long-term impact of a drug use that has not been extensively studied.

The study authors cited several reasons as to why the high percentage of off-label prescribing is occurring, with some reasons being legitimate and others not. The practice itself raises issues that require addressing, including a better/faster process for getting legitimate additional uses for a drug indicated, but also for ensuring patient safety for patients dutifully following an off-label treatment protocol as prescribed by physicians they trust.

Posted by: Sylvia

Additional reading:

[url:1921,type=|node|]
[url:1948,type=|node|]
[url:808,type=|node|]

Lumbar Artificial Disc Replacement Not Covered In People Over 60

Mon, 27 Aug 2007 12:00:42 -0700

August 27, 2007
by: Sylvia Marten

Medicare has decided it will not pay for lumbar artificial disc replacements in people over 60 years of age. The reasoning for the CMS' (The Centers for Medicare and Medicaid Services) decision is the lack of data on using such devices in the 60+ population, according to Scott Boden, MD, a Spine-health.com Medical Advisor.

This August 2007 decision affects the Prodisc-L (made by Synthes), approved by the FDA in August 2006. The first lumbar artificial disc approved by the FDA in 2004, the Charite disc (made by DePuy Spine, a Johnson & Johnson company), was already covered by a similar decision made by CMS in May 2006.

Both the Prodisc and Charite disc FDA IDE clinical studies tested patients between the ages of 18 and 60. Based on the age limitations in these studies and in Medtronic’s Maverick lumbar disc study, CMS says it “is convinced that the indications for LADR will exclude the over age 60 population, and that these age limitations are not specific to one manufacturer’s disc implant.”

What about people under age 60 with pain and disability from lumbar degenerative disc disease, the prevalent and severe condition the artificial disc was designed to treat? It’s still left up to individual insurance companies to decide. The CMS acknowledged “some evidence does exist for patients age 60 and under” to benefit from artificial disk technology. However, it believes the ProDisc clinical trial design created more uncertainty in benefits and thus would not come forth with a statement supporting artificial disc replacement in the under age 60 population.

For those of you interested, the exact wording of the decision is below.

The original CMS decision about Lumbar Artificial Disc Replacement was made on May 16, 2006, and was specific to the Charite Disc, the only lumbar artificial disk available at the time:

“LADR with the Charite^TM lumbar artificial disc is not reasonable and necessary for the Medicare population over 60 years of age; therefore, LADR with the Charite^TM lumbar artificial disc is non-covered for Medicare beneficiaries over 60 years of age. For Medicare beneficiaries 60 years of age and younger, there is no national coverage determination, leaving such determinations to continue to be made by the local contractors. Medicare coverage under the investigational device exemption (IDE) for other lumbar artificial discs in eligible clinical trials is not impacted.”

On August 14, 2007, the CMS issued the following in its decision memo:

“The Centers for Medicare and Medicaid Services (CMS) has determined that LADR is not reasonable and necessary for the Medicare population over sixty years of age. Therefore, Section 150.10 of the Medicare National Coverage Determination (NCD) Manual is amended to reflect the change from non-coverage for LADR with a specific implant to non-coverage for the LADR procedure for the Medicare population over sixty years of age. For Medicare beneficiaries sixty years of age and under, there is no national coverage determination, leaving such determinations to be made on a local basis.”

Further reading:

CMS decision memo for Lumbar Artificial Disc Replacement
[url:1734,type=|node|]

Posted by: Sylvia

New Research on Interlaminar Epidural Steroid Injections for Back Pain and Sciatica

Fri, 03 Aug 2007 14:50:58 -0700

August 3, 2007
by: Sylvia Marten

It should be noted that interlaminar epidural injections are different than transforaminal epidural steroid injections (also called spinal nerve blocks) and that transforaminal epidural steroid injections have been shown to be effective for sciatica in clinical trials.

The effectiveness of lumbar interlaminar [url:6010,type=|node|,content=|epidural steroid injections|] for treatment of lower back pain and sciatica continues to be a hotly debated topic.

Some physicians view epidural steroid injections as an important pain relief treatment option for many patients with severe lower back pain that radiates down the leg. They would argue that, while it doesn’t work for everyone, an epidural steroid injection is one of the only non-surgical options that can provide almost immediate pain relief for severe sciatica. Others view the recent reviews as evidence that interlaminar injections should not be performed.

As always, the devil is in the details, and significant details are left out of the clinical trial reviews. Most notably:

The injection protocol in the studies cited do not include the use of fluoroscopy or x-ray to verify proper placement of the medication, despite the fact that fluoroscopic guidance is an important factor in the success of the procedure and is routinely used today.
Most of the studies do not classify patients according to diagnosis and tend to 'lump' different types sources of pain together.

"These methodological flaws are considerable and make it difficult to impossible to draw conclusions from the studies. More clinical studies are needed to properly define the role of epidural steroid injections in low back pain and in sciatica" states Ray Baker, MD, a pain management physician in Bellevue Washington and Medical Advisor for Spine-health.com.

Until more definitive and reliable research is available, patients are advised to make sure that they:

Enlist the services of professionals with extensive experience in doing epidural steroid injections
Always use fluoroscopy to ensure accurate placement
Follow the generally accepted guidelines of limiting the number of [url:168,type=|term|,content=|injections|] to a maximum of three within any one-year period

Sources:

American Academy of Neurology
[url:168,type=|term|]

Brain Imaging Shows how Pain Interferes with Concentration

spine-health — Mon, 09 Jul 2007 18:19:58 -0700

July 9, 2007
by: Stephanie

When experiencing pain, the lateral occipital complex (LOC) part of the brain is affected, interfering with the person's ability to concentrate and accurately identify visual images, according to new research published in the July 5 issue of Neuron.

In the study, volunteers performed a cognitive task and a memory task, while a laser beam was applied to their hands to create pain. (I hope these volunteers were compensated!) An MRI scan of the volunteers' brain function during the task showed that the LOC part of the brain was engaged both during the tasks and the pain, as well as a second area of the brain that processes pain. The researchers inferred that this second area of the brain may interfere with the LOC's cognitive function and ability to recognize images when people are in pain.

For those of you dealing with [url:137,type=|term|,content=|chronic pain|], if you can't finish a complete sentence without losing your train of thought it may not be just the pain medications - it may be how your brain is dealing with the pain. On the bright side, at least you have an excuse - I don't have chronic pain but still have trouble completing a thought. Now to go find someone to proofread this post before publishing it...

Posted by: Stephanie

Does Pain Prefer Sweets?

Thu, 05 Jul 2007 13:00:26 -0700

July 5, 2007
by: Stephanie

For all of you with chronic pain who are thinking "yes, a pint of Ben & Jerry's really does help the pain", that's true - sweet tastes have been shown to increase pain tolerance, and now new research shows the same holds true for sweet smells. Quite simply, the perception of pain diminishes when one is smelling something sweet. ScienceBlogs explains the research:

"They started with three types of smells: sweet and pleasant (caramel), unsweet and pleasant (after shave), and unpleasant (civet musk, which I hear smells awful). The inclusion of both sweet and unsweet pleasant smells allowed Prescott and Wilkie to distinguish between the analgesic effects of the pleasantness of the smell from that of the sweetness (apparently these two properties had been confounded in previous studies). The smells were placed on the inside of a mask, which participants were told was used to measure their breathing rate so that they would have no knowledge of the experiment's purpose. Participants put on the mask, and then placed their hands into a vat of water at 5° Celsius (41° Fahrenheit) for up to 4 minutes. They did this in two trials, separated by 15 minutes, one trial with the smell and one without (they wore the mask for both). The key measure was how long participants kept their hand in the cold water. Prescott and Wilkie also asked them to rate how intense the pain was right after putting their hands in, thirty seconds later, and when they pulled their hands out of the water."

The results of the study show that specifically the sweet smell helped people tolerate the pain - and that group kept their hands in the water more than twice as long, on average, than the participants in the other two conditions, when the smell was present...The actual, subjective perception of pain did not differ across all three conditions, so it seems that the participants subjectively experienced the same levels of pain, but they were able to tolerate it better when the sweet and pleasant smell was present.

The researchers also hypothesized that the analgesic effects of sweet smells are likely the result of learned associations. Whatever the reason, you might want to try popping a few chocolate chip cookies into the oven, or whatever is sweet that you associate with good things, to make your pain more tolerable.

Posted by: Stephanie

Source: Prescott, J., & Wilkie, J. (2007). Pain tolerance selectively increased by sweet-smelling odor. Psychological Science, 18(4), 308-311.

More reading: [url:137,type=|term|,content=|Chronic Pain Health Hub|]

Lyrica Approved to Treat Fibromyalgia

spine-health — Mon, 25 Jun 2007 14:14:57 -0700

June 25, 2007
by: Stephanie

On June 21 the FDA approved Lyrica (pregabalin) as the first drug specifically indicated to treat pain from fibromyalgia. Lyrica is an analgesic (pain relieving) and anit-convulsant medication that is also approved to treat [url:137,type=|term|,content=|chronic pain|]. The study results submitted to the FDA for approval showed that 30 to 60% of study participants experienced significant pain relief with Lyrica.

It is not known exactly how Lyrica works to reduce pain in patients with fibromyalgia. It is thought that the drug may effect how neurotransmitters (chemicals in the brain) transmit signals from one neuron to another.

The data submitted to the FDA were from two randomized, placebo-controlled trials of about 1800 adults. These trials showed that treatment with Lyrica in doses of 300-450 mg per day reduced pain and improved function in patients with Fibromyalgia, and symptoms became worse when the people stopped taking Lyrica.

There are a number of potential risks and side effects with Lyrica, including but not limited to dizziness and sleepiness, blurry vision, impaired motor function, weight gain, trouble concentrating, swelling of the hands and feet, dry mouth, and potential allergic reactions. Side effects, which are somewhat correlated with dosage, may be significant and impair one's ability to drive.

Source:

FDA website - lyrica approval

FDA consumer health information

Posted by: Stephanie

Chronic Pain May Interfere with Memory

spine-health — Fri, 22 Jun 2007 13:23:46 -0700

June 22, 2007
by: Stephanie

One more problem with chronic pain: it may impede the brain’s ability to form and store memories, according to recent research.

In the study, 24 adults with [url:137,type=|term|,content=|chronic pain|] took simple memory tests at two different times: one test after having a procedure to relieve their pain (e.g. an epidural injection for chronic low back pain), and another on a day when they hadn't received any pain relieving procedure.

The findings: Two-thirds of the patients had more difficulty with memory on the days when they hadn't had a recent pain-relieving procedure.

According to the researchers, the study indicates that chronic pain may disrupt the brain’s ability to hold and store memories.

Frequent comments on our message board about difficulty with remembering things anecdotally – and often humorously - support these findings.

Posted by: Stephanie

Source: Dick, B. Anesthesia & Analgesia, May 2007; vol 4: pp 1223-1229. News release, University of Alberta

How Chronic Back Pain Gets Stuck in Your Brain

spine-health — Fri, 15 Jun 2007 18:16:59 -0700

June 15, 2007
by: Stephanie

Dr. Vania Apkarian, a professor at the Northwestern University Feinberg School of Medicine, published a study last year that revealed how chronic back pain actually registers in a different part of the brain (the prefrontal cortex) than acute pain (the thalamus). Dr. Apkarian also found that the longer a person has been suffering from chronic pain, the more activity there was in the prefrontal cortex. He was able to accurately determine the number of years the person had experienced back pain just by reading the MRI scan - the scans showed a cumulative tape of how much pain the brain had registered.

Basically, Dr. Apkarian has identified that with chronic pain there appears to be an old memory that essentially gets stuck in a rut in the prefrontal cortex - the part of the brain that governs emotions and learning. Even after the injury/original problem that caused the pain is healed, the brain seems to keep remembering the problem and can't forget it.

More recently, in a follow-up study using laboratory rats, Dr. Apkarian has found that the drug D-Cycloserine seems to help erase or at least dampen that memory. The rats in the study who had [url:137,type=|term|,content=|chronic pain|] from an injured limb seemed to be pain-free after 30 days of treatment with the drug.

The findings have been published in the online version of the journal Pain. Plans are in the works to start a clinical trial.

If this drug works in humans, it would be a very exciting development for many of those coping with chronic back pain.

Posted by: Stephanie

More resources:

New Study on Physical Therapy for Low Back Pain

Mon, 11 Jun 2007 14:39:44 -0700

June 11, 2007
by: Stephanie

John at MyPHysicalTherapySpace points out an interesting new study on the effects of physical therapy on low back pain.

This study evaluated the effectiveness of [url:171,type=|term|,content=|physical therapy|] exercise sessions and advice vs. sham exercises and advice over a 12 month period for individuals with subacute low back pain (lasting longer than 6 weeks but less than 12 weeks).

Surprising results: "Exercise and advice were each slightly more effective than placebo at 6 weeks but not at 12 months".

Posted by: Stephanie

Back Surgery Best for Patients with Degenerative Spondylolisthesis

Wed, 06 Jun 2007 17:53:41 -0700

June 6, 2007
by: Sylvia Marten

Surgery Videos

The recently released results of the second SPORT study showed that patients who selected surgery to treat their [url:709,type=|node|,content=|lumbar degenerative spondylolisthesis|] had better outcomes when compared with those who selected nonsurgical treatment. The study included two groups of patients:

Randomized group – 304 patients
In the randomized group, 304 patients were randomly selected to receive either standard posterior decompressive [url:6023,type=|node|,content=|laminectomy|] (with or without a [url:1582,type=|node|,content=|spinal fusion|]) or nonsurgical care. Nonsurgical treatments included [url:171,type=|term|,content=|physical therapy|], epidural steroid injections, NSAIDS, and opioids. There was significant crossover from patients in the surgical and nonsurgical groups, with 64% of the surgical group having surgery and 49% of patients assigned to nonsurgical care also having surgery.

Because of the large percentage of patients who crossed over to from non-surgical treatment to surgical and vice-versa, the results of the study are really only meaningful by evaluating how the patients were actually treated, (vs. by their randomized groups).

Observational group – 303 patients
This group was allowed to choose whether to have surgery or receive nonsurgical treatment. 97% of patients who selected surgery went through with the operation, and 25% of the nonsurgical group ultimately chose surgical treatment.

The surgery for [url:6000,type=|node|,content=|spondylolisthesis|] included a decompressive laminectomy with or without an accompanying spinal fusion.

The large cross-over of patients and the favorable outcomes show what doctors and patients already know: those with pain fare best when their care was left to the individual discretion of patient and surgeon.

Primary source:

Surgery vs. Non-surgical Treatment for Lumbar Degenerative Spondylolisthesis

Surgery best for degenerative spondylolisthesis

Wed, 06 Jun 2007 13:59:36 -0700

June 6, 2007
by: Sylvia Marten

The recently released results of the second SPORT study showed that patients who selected surgery to treat their lumbar degenerative spondylolisthesis had better outcomes when compared with those who selected nonsurgical treatment. The study included two groups of patients:

Randomized group – 304 patients

In the randomized group, 304 patients were randomly selected to receive either standard posterior decompressive laminectomy (with or without a spinal fusion) or nonsurgical care. Nonsurgical treatments included physical therapy, epidural steroid injections, NSAIDS, and opioids. There was significant crossover from patients in the surgical and nonsurgical groups, with 64% of the surgical group having surgery and 49% of patients assigned to nonsurgical care also having surgery.

Observational group – 303 patients

This group was allowed to choose whether to have surgery or receive nonsurgical treatment. 97% of patients who selected surgery went through with the operation, and 25% of the nonsurgical group ultimately chose surgical treatment.

The study showed that patients in both groups who chose surgery to treat their lumbar degenerative spondylolisthesis and spinal stenosis fared significantly better in terms of pain relief and function at 3 months, 1 year, and 2 years than those who received non-surgical treatment. The surgery for spondylolisthesis included a decompressive laminectomy with or without an accompanying spinal fusion. The large cross-over of patients and the favorable outcomes show what doctors and patients already know: those with pain fare best when their care was left to the individual discretion of patient and surgeon. Primary source: Surgery vs. Non-surgical Treatment for Lumbar Degenerative Spondylolisthesis

The Ultimate in Multi-Tasking - Lose Weight While Working at Your Desk

spine-health — Tue, 29 May 2007 18:48:49 -0700

May 29, 2007
by: Stephanie

If it works, this could be the best weight loss invention yet - the ability to easily burn almost 120 extra calories per hour while working at your computer.

The origin of this thinking comes from Dr. James Levine, an endocrinologist at the Mayo Clinic, who found that any incremental movement, even fidgeting, burns extra calories. From this, he extrapolated that even very light aerobic activity would cause the body to greatly increase the rate at which it burns calories, a process called non-exercise activity thermogenesis.

To study his hypothesis, he invented a computer workstation that can be used while walking slowly - very slowly - on a treadmill, and recently released the results of a small research study that evaluated how many calories this would burn.

The recent study included 15 obese individuals - 14 women and one man - in their forties who did no regular exercise. Their average Body Mass Index (BMI) was 32 and percent body fat was 52%. Using the treadmill at 1mph burned 119 more calories per hour during the study than sitting while working, which would indicate that walk-working for 2 to 3 hours per day could lead to a weight loss of about 45 pounds in a year according to Dr Levine.

The author acknowledged that the study was limited by several factors, including its short duration, which did not extend throughout an entire workday, the small number of subjects, and the concentration of women.

My personal sense is that while this is attractive in theory, I would rather separate work and exercise. I much prefer the mood enhancing qualities from the endorphins produced by a good aerobic workout over low level activity.

Primary source: The energy expenditure of using a "walk-and-work" desk for office-workers with obesity. BritishJournal of Sports Medicine online.

Posted by: Stephanie Burke