title: Operations in spinal surgery are not always needed. Do we operate more than we should?
abstract: Lumbar disc herniation and low back pain are the main cause of sickness during labor life. The decision for operation is thought to be taken easily and as a result a lot of money is being spent for treatment and rehabilitation. The aim of this study was to evaluate whether conservative treatment is sufficient for treatment of lumbar disc herniation and low back pain and what percentage of the patients operated are satisfied with social and everyday life two years after operation. One hundred and twenty seven patients (67 male and 60 female) were treated because of lumbar disc herniation. No neurological deficiency or muscle weakness was observed. Seventy two patients underwent conservative treatment. Fifty five patients underwent microsurgical discectomy. Back and leg pain are reported on a visual analog scale (VAS) and with the Oswestry disability index (ODI). The Short Form-36 health survey (SF-36) and the European Quality of Life questionnaire (EQ-5D) should also be completed. Surgical data, including diagnosis, are recorded by the surgeon without access to the patient's questionnaires. Both groups (conservative and operative) improved from baseline with regard to SF-36 and ODI (all P<0.01). The results 2 years after surgery were similar for both groups, as measured with the SF-36 and the ODI. Both groups improved from baseline to follow-up with regard to both back pain and leg pain (all P<0.01). The frequency of returning to work was analyzed for those patients who were less than 65 years of age at the time of follow up, and who had been working before surgery. Statistical analysis indicates that there are no significant differences between the groups. The decision for operation is thought to be taken easily and as a result a lot of money is being spent for treatment and rehabilitation. In conclusion, this study shows that operative treatment is equal in outcome to conservative treatment and should follow, seen from an economic perspective, the conservative treatment.
authors.affiliation: Department of Orthopaedic Surgery, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany. kafchitsas@googlemail.com, Kafchitsas@em.uni-mainz.de.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kafchitsas
authors.forename: Bjoern
authors.initials: B
authors.lastname: Habermann
authors.forename: Fawad M
authors.initials: FM
authors.lastname: Khan
authors.forename: Charalampos
authors.initials: C
authors.lastname: Matzaroglou