Study: Spondylolisthesis and spinal stenosis patients with leg pain have better surgery results

Jun 6 2011
When conservative treatment options for low back pain are exhausted, many patients are faced with the prospect of spine surgery. Unfortunately, the choice of procedure and prognosis are not always clear cut.

Advancements in orthopedic medicine have created more options in recent years, including minimally invasive procedures. Endoscopic surgeries typically require less anesthesia and smaller incisions, resulting in faster recovery times and a lower risk of infection. This has expanded the pool of potential candidates for back surgery to encompass busy individuals, such as professionals or parents of small children, who previously did not have the time for long periods of bed rest.

Another problem, and one that has not been entirely resolved, stems from the uncertainty of making predictions regarding surgery outcomes. In effect, doctors have to walk a fine line between encouragement and managing patients' expectations, and ultimately they have to rely on their experience to make an educated guess about the level of mobility and quality of life the patient will have following their operation.

However, new studies are increasingly providing doctors and patients with tools to gauge future surgery results better. For example, Anesthesiology News reported on the findings of the Spine Patient Outcomes Research Trial (SPORT), which suggested that individuals diagnosed with degenerative spondylolisthesis (DS) and spinal stenosis (SpS), who present with predominant leg pain, tend to have better spine surgery outcomes.

Those outcomes included higher levels of pain relief and better mobility at one year follow-up, as compared to non-surgical methods. Moreover, DS patients fared better than those with SpS.

The subjects of the study included patients with DS and SpS whose primary region of pain was their leg and who subsequently underwent a surgery. For comparison, the researchers also looked at patients with the same two conditions who presented with lower back pain and those who complained of pain in both regions.

Y. Raja Rampersaud, MD, associate professor of orthopedics and neurosurgery at the University of Toronto, said this discovery confirms the findings of other studies conducted across North America. However, he cautioned against assuming that surgery does not work for patients who mainly have back pain. The only thing that these results suggest is that leg-predominant patients can expect a better outcome.

Spondylolisthesis occurs when a vertebra in the lower part of the spine slips out of the proper position with respect to the bone below. Spinal stenosis is characterized by the narrowing of the spinal canal that causes pressure on the spinal cord.