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Thread: Improvement of back pain with operative and nonoperative treatment in adult scoliosis

  1. #1
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    Improvement of back pain with operative and nonoperative treatment in adult scoliosis

    OBJECTIVE: The purpose of this study was to assess whether back pain is improved with surgical treatment compared with nonoperative management in adults with scoliosis.

    Inclusion criteria for the current study included the following: 1) patients enrolled in the Adult Deformity Outcomes section database between January 2002 and February 2006, 2) primary diagnosis of adult untreated idiopathic or degenerative (de novo) scoliosis (Cobb angle >10 degrees), 3) presence of back pain (NRS score for back pain > 0) at baseline, 4) documentation of NRS score for back pain at 2 years, and 5) age older than 21 years. Patients with a history of spine surgery consisting of minor decompressions and/or short segment fusions were not excluded from this study. All patients included, both operative and nonoperative, had 2 years of follow-up.


    RESULTS: Of 317 patients with back pain, 147 (46%) were managed surgically. Compared with patients managed nonoperatively, operative patients had higher baseline mean NRS (numeric rating scale) scores for back pain (6.3 versus 4.8; P < 0.001), higher mean ODI (Oswestry Disability Index) scores (35 versus 26; P < 0.001), and lower mean SRS-22 scores (3.1 versus 3.4; P < 0.001). At the time of the 2-year follow-up evaluation, nonoperatively managed patients did not have significant change in the NRS score for back pain (P = 0.9), ODI (P = 0.7), or SRS-22 (P = 0.9). In contrast, at the 2-year follow-up evaluation, surgically treated patients had significant improvement in the mean NRS score for back pain (6.3 to 2.6; P < 0.001), ODI score (35 to 20; P < 0.001), and SRS-22 score (3.1 to 3.8; P < 0.001). Compared with nonoperatively treated patients, at the time of the 2-year follow-up evaluation, operatively treated patients had a lower NRS score for back pain (P < 0.001) and ODI (P = 0.001), and higher SRS-22 (P < 0.001).


    CONCLUSIONS: Despite having started with significantly greater back pain and disability and worse health status, surgically treated patients had significantly less back pain and disability and improved health status compared with nonoperatively treated patients at the time of the 2-year follow-up evaluation. Compared with nonoperative treatment, surgery can offer significant improvement of back pain for adults with scoliosis.


    Smith, Justin S. M.D., Ph.D.; Shaffrey, Christopher I. M.D.; Berven, Sigurd M.D.; Glassman, Steven M.D.; Hamill, Christopher M.D.; Horton, William M.D.; Ondra, Stephen M.D.; Schwab, Frank M.D.; Shainline, Michael M.S.; Fu, Kai-Ming M.D., Ph.D.; Bridwell, Keith M.D.; The Spinal Deformity Study Group
    Congress of Neurological Surgeons.
    July, 2009.
    45L/40T
    Surgery 25/1/2010
    Australia

    Knowthyself

    Scoliosis Corrected 25/1/2010 by Dr Angus Gray, Prince of Wales Private Hospital, Sydney. Fused T3-L4.

  2. #2
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    Thanks for posting that. As I said in a previous post, Iím baffled why people choose increasing debilitating pain when surgical intervention can give back oneís life. Last Saturday I had cousins in from out of town and we went into the city to see a play. It was a 10-hour day of sitting and shuffling from train to taxi to theater and back to taxi and train and then to restaurant for dinner. All the time I experienced no pain. Just two years ago I would have had to stay home because my back would have been killing me by the time I got to the restaurant.

  3. #3
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    Hi Chris,

    When I think back over the last 4 years, and remembering some of your previous posts, and now reading what you just said makes me smile and chuckle!!!

    I thinks it's awesome how you have done a 360*, not counting the degrees of correction you also had.

    It just goes to show how honest you are. Anyone that's going through the process of debating this "elective" surgery should go back and read some of your posts.

    You fought the good fight, some of us fought back. I often thought about certain people that I had come to know here, and wondered how they we're doing. I was glad to see that you were still here and finally "log rolled" over to the side of post-oppies.

    Makes me smile and glad that you are happy with your choice!!!

    It's people like you that were sent here for a purpose. I'm proud of you and your honesty and I hope people read some of your older posts, you're a feisty one!!!

    All my best,
    Shari

  4. #4
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    Thanks for your kind words, Shari. Yes, I will admit to having been absolutely TERRIFIED of this surgery. And when I would read posts of post-op people who were still experiencing problems, I found myself second-guessing the whole thing over and over. But as Linda Racine has so often mentioned, the majority of post-ops get on with their lives and no longer find the need for a support forum. I just wanted to stick around a while to let others know that there are indeed plenty of success stories, and Iím one of them.

    One of my favorite quotes that came my way on a day I was so overwhelmed with fear over this surgery that I thought I would have a nervous breakdown is the following:

    ďFears cannot survive without your full attention. Lord, help me to face my fears, realize that they are not as big as I imagine and see that their main purpose is to stop me from action. ď

    I would often receive similar messages via email or sent to my home address in the days preceding my surgery. I swear they were heaven sent.

  5. #5
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    I have the utmost respect for this study. UCSF is participating, and I've been working with Dr. Berven for the past 6 mos. or so, on a volunteer basis, mostly on this study.

    With that said, one thing that I've come to know about most studies is that the patients who go to surgeons have a form of vested interest in a good surgical outcome, while the patients who go to surgeons and are told they're not good candidates for surgery, and who are sent for conservative management, have a vested interest in a bad outcome. (The same holds true for the relatively scarce alternative treatment outcome studies. The people who go to alternative providers have a vested interest in a good outcome.) We've seen extensive evidence of both right here.

    --Linda


    Quote Originally Posted by Jimbo View Post
    OBJECTIVE: The purpose of this study was to assess whether back pain is improved with surgical treatment compared with nonoperative management in adults with scoliosis.

    Inclusion criteria for the current study included the following: 1) patients enrolled in the Adult Deformity Outcomes section database between January 2002 and February 2006, 2) primary diagnosis of adult untreated idiopathic or degenerative (de novo) scoliosis (Cobb angle >10 degrees), 3) presence of back pain (NRS score for back pain > 0) at baseline, 4) documentation of NRS score for back pain at 2 years, and 5) age older than 21 years. Patients with a history of spine surgery consisting of minor decompressions and/or short segment fusions were not excluded from this study. All patients included, both operative and nonoperative, had 2 years of follow-up.


    RESULTS: Of 317 patients with back pain, 147 (46%) were managed surgically. Compared with patients managed nonoperatively, operative patients had higher baseline mean NRS (numeric rating scale) scores for back pain (6.3 versus 4.8; P < 0.001), higher mean ODI (Oswestry Disability Index) scores (35 versus 26; P < 0.001), and lower mean SRS-22 scores (3.1 versus 3.4; P < 0.001). At the time of the 2-year follow-up evaluation, nonoperatively managed patients did not have significant change in the NRS score for back pain (P = 0.9), ODI (P = 0.7), or SRS-22 (P = 0.9). In contrast, at the 2-year follow-up evaluation, surgically treated patients had significant improvement in the mean NRS score for back pain (6.3 to 2.6; P < 0.001), ODI score (35 to 20; P < 0.001), and SRS-22 score (3.1 to 3.8; P < 0.001). Compared with nonoperatively treated patients, at the time of the 2-year follow-up evaluation, operatively treated patients had a lower NRS score for back pain (P < 0.001) and ODI (P = 0.001), and higher SRS-22 (P < 0.001).


    CONCLUSIONS: Despite having started with significantly greater back pain and disability and worse health status, surgically treated patients had significantly less back pain and disability and improved health status compared with nonoperatively treated patients at the time of the 2-year follow-up evaluation. Compared with nonoperative treatment, surgery can offer significant improvement of back pain for adults with scoliosis.


    Smith, Justin S. M.D., Ph.D.; Shaffrey, Christopher I. M.D.; Berven, Sigurd M.D.; Glassman, Steven M.D.; Hamill, Christopher M.D.; Horton, William M.D.; Ondra, Stephen M.D.; Schwab, Frank M.D.; Shainline, Michael M.S.; Fu, Kai-Ming M.D., Ph.D.; Bridwell, Keith M.D.; The Spinal Deformity Study Group
    Congress of Neurological Surgeons.
    July, 2009.

  6. #6
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    Quote Originally Posted by hdugger View Post
    Thanks, Linda. I was going to post about this (but forgot). There's something called cognitive dissonance that makes you invested in a good outcome when you've put some energy into it. So, if you bought an expensive car, you'll be inclined to say you love it. But, if it's given to you, you might not.

    I do notice that on this forum. The people with pain after surgery tend to put a better spin on it then the people with pain who have not had surgery.
    I have chalked that up to the outcome that most patients have less or less severe pain compared to before surgery. Or are you saying they are only claiming it is less or less severe because of the emotional investment in the surgery? How would we know the difference? Perhaps I'm not following your point?

    I'm not sure, though, why people with alternative treatments would have a vested interest in a bad outcome.
    Because they don't expect it to work? Then they can say they guessed right? I'm just speculating here.

    [Edit: Looking up cognitive dissonance, I don't see exactly this, although I see the opposite "sour grapes" thing. But I'm pretty sure cognitivie dissonance covers both states.]
    Yes you are correct.

    http://en.wikipedia.org/wiki/Cognitive_dissonance

    The part on "Postdecision Dissonance" seems relevant.

    But positive thinking actually works in some cases. I think people who do report less pain after surgery but who still might have the same physiological level of pain (not sure how the heck you would show that) probably do perceive the pain as less.

    So you would have to separete cogitiive dissonance from positive thinking I would imagine.

    This psych stuff is complex and more of an art it seems.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  7. #7
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    Quote Originally Posted by hdugger View Post
    I'm not sure, though, why people with alternative treatments would have a vested interest in a bad outcome.
    I see it a lot. People who want to have the surgery, but who are denied surgery until they try conservative treatments, aren't likely to have any relief from non-surgical therapies.

    --Linda

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