Total disc replacement vs. rehabilitation for low back pain: 6 things to know


A new study published in The Spine Journal compares outcomes between total disc replacement and nonoperative rehabilitation for patients with chronic low back pain and localized disc degeneration in the lumbar spine.


The study included 173 patients, 77 of which underwent total disc replacement and 74 of which underwent randomized rehabilitation. The study authors followed patients for eight years and compared their progress. The study authors found:


1. The average Oswestry Disability Index score was 20 points for the surgery group and 14.4 points for the rehabilitation group, and at the eight year follow up the difference between the two averages was 6.1.


2. The VAS secondary outcomes scores favored the surgical intervention patients by 9.9 points; HSCL-25 scores also favored surgical intervention patients by 0.16 points.


3. Twenty-four percent of the patients in the surgery group and 6 percent of the patients in the rehabilitation group reported full recoveries after treatment.


4. Patients in both groups reported similar EQ-5D, occupational status and care satisfaction after treatment. There wasn't a significant difference in postoperative drug use based on the treatment method.


5. The researchers conducted a per protocol analysis and found the average difference in ODI scores favored the surgical intervention group by 8.1 points; 70 percent of the surgery group and 50 percent of the rehabilitation group reported clinically important improvement. Both groups reported similar clinically important deterioration.


6. Twenty-one patients in the rehabilitation group crossed over and underwent back surgery, and 12 patients in the surgical group underwent additional back procedures. There was one serious adverse event in the surgical group.


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