SURGERY OR CONSERVATIVE MANAGEMENT FOR LUMBAR SPINAL PAIN: WHAT DOES THE EVIDENCE SAY?


Supreet Bindra

ABSTRACT
The prevalence and impact of chronic low back pain have spawned a rapidly expanding range of tests and treatments. The increasing costs, complications and overutilization of treatments for back pain have been strongly condemned. Thus there is a need to review definitive treatments for back pain. The paper discusses the literature on success of surgical versus conservative management of back pain. Data from both randomized and observation studies suggest a symptomatic benefit at least in first 5 years with surgery in patients with persistent sciatica. But at the same time the outcomes without surgery are generally quite favorable and patients with mild symptoms have good prognosis without surgery. The decision to use surgical care should always be preceded by patient’s participation in an active exercise program and probably after multidisciplinary investigation and consultation. If surgery is warranted, it should not be delayed so long that the function deteriorates but should be undertaken for the correct indications as soon as possible