The North American Spine Society's 25th Annual Meeting took place Oct. 5-9 in Orlando, Fla., and attracted approximately 7,000 participants from around the world. The conference focused on advancement of spine care, providing the latest information in spine education, research, and innovation.
In the Spine Patient Outcomes Research Trial (SPORT), Adam Pearson, M.D., M.S., of Dartmouth Hitchcock Medical Center in Lebanon, N.H., and colleagues found that patients improved more with surgery than with nonsurgical intervention. The investigators evaluated 1,192 patients who had radiculopathy, with neurological findings and intervertebral disc herniation confirmed with cross-sectional imaging.
Although the data revealed that all subgroups improved significantly more with surgery than with nonsurgical intervention, treatment effects differed substantially among the subgroups, with joint problems, being single, and having an unchanging health trend predicting smaller treatment effects. Although some subgroups experienced poor outcomes with surgery, some of these groups also had particularly poor nonsurgical outcomes.
"It suggests that people with lower educational attainment, longer duration of symptoms, and possibly some psychological problems -- patients who in the past were the type of patient we might have discouraged from having surgery -- may in fact be the patients who benefit most from surgery," Pearson said in a statement.
In a subanalysis of the SPORT trial, Jeffrey Rihn, M.D., of Thomas Jefferson University Hospital in Philadelphia, and colleagues found that obesity should not always be a contraindication for surgical treatment of degenerative conditions of the lumbar spine. The investigators evaluated how obesity affects outcomes for lumbar intervertebral disc herniation, spinal stenosis, and degenerative spondylolisthesis.
"We found that patients with obesity treated for disc herniation didn't do as well with treatment, whether nonoperative or surgical treatment, than those who were not obese. Obese patients with stenosis didn't do as well with nonoperative treatment but did just as well with surgical treatment as those who were not obese. In addition, patients with disc herniation or stenosis who underwent surgical treatment did not experience increased rates of infection, complications, or reoperation," Rihn said.
The investigators also found that obese patients with degenerative spondylolisthesis experienced mixed results but tended to do equally well with surgery but not as well with nonoperative treatment compared with nonobese patients. Obese patients treated surgically for degenerative spondylolisthesis experienced increased rates of infection (P = 0.05) and increased rates of reoperation (P = 0.01) at four years of follow-up.
"This data is important when counseling obese patients with these lumbar conditions. Obese patients with disc herniation may not do as well with surgery or nonoperative treatment as nonobese patients. Surgery seems to be more effective than nonoperative treatment in obese patients with stenosis and degenerative spondylolisthesis," Rihn said.
In a large, prospective trial, Michael G. Fehlings, M.D., Ph.D., of the University of Toronto, and colleagues found that surgical treatment for cervical spondylotic myelopathy (CSM) significantly improved outcomes one year postsurgery. The investigators evaluated 280 patients with clinically symptomatic CSM, using the modified Japanese Orthopaedic Association (mJOA) score, the Nurick score, the SF-36, and the Neck Disability Index (NDI) to assess outcomes. At two years' follow-up, mJOA scores had improved by 3.02 points, the Nurick score had improved by 1.64 points, the Neck Disability Index had improved by 11.06 points, the SF-36 physical component summary score had increased by 5.7 points, and the SF-36 mental component summary score had improved by 4.89 points. Patients did better when symptoms were of less than six months' duration.
"Surgical decompression for cervical spondylotic myelopathy (CSM) is highly effective and safe," Fehlings said in a statement. "The duration of clinical symptoms has an adverse impact on outcomes, and hence earlier diagnosis and referral is important."
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