“Can spinal surgery
be prevented by treating surgical candidates with
aggressive strengthening exercise? A prospective
study of cervical and lumbar patients.” B.
Nelson, D. Carpenter, T. Dreisinger, M. Mitchell,
E. O'Reilly, C.
Kelly, J.
Wegner, A.
Coulter, J.
Palen, and M. Hogan. Archives of Physical Medicine
and Rehabilitation 80:20-25, 1999.
ABSTRACT:
Objective: To determine if patients recommended
for spinal surgery can avoid the surgery through
an aggressive strengthening program.
Setting: A privately
owned clinic, staffed by physicians and physical therapists,
that provide treatment for patients with neck and/or
back pain.
Methods: Over a period
of 2 1/2 years, consecutive patients referred to the
clinic for evaluation and treatment were enrolled in
the study if they (1) had a physician's recommendation
for lumbar or cervical surgery, (2) had no medical
condition preventing exercise, and (3) were willing
to participate in the approximately 10-week outpatient
program. Treatment consisted mainly of intensive, progressive
resistance exercise of the isolated lumbar or cervical
spine. Exercise was continued to failure, and patients
were encouraged to work through their pain. Third-party
payors in Minneapolis were surveyed of average costs.
Average follow-up occurred 16 months after discharge.
Results: Results:
Forty-six of the 60 participants completed the program.
At an average of 16 months after completion, 38 patients
were available for follow-up while 8 patients could
not be located or contacted. Of these 38 patients only
three required surgery after completing the program.
Discussion/Conclusions: Despite
methodologic limitation, the results are intriguing.
A large number of patients who had been told they
needed surgery were able to avoid surgery in the
short term by aggressive strengthening exercise.
This study suggests the need to define precisely
what constitutes "adequate conservative care."
©1999 by the American Congress of
Rehabilitation Medicine and the American Academy
of Physical Medicine and Rehabilitation
