Updated: Sep 27
From a general stand-point, if you need surgery, it's likely to be the best thing for you. The problem we run into in physical therapy is that many surgeries are not the best thing for the patient, and the outcomes at 5 years are probably no better than conservative care, but with all the complications that come with surgery.
To break down some of the data, here is a review of 14 articles following 1658 patients who received either a microdiscectomy or conservative care.
"Nine RCTs (14 articles) and 1658 patients were included, and three of them were high-quality studies. At first 6 months after treatment, there were no significant differences for ODI (Oswestry Disability Index) scores between two therapeutic groups (P > 0.05), however, surgery group showed significant higher ODI scores at one year (P < 0.05) and two years (P < 0.05). Two studies reported no significant difference between laminectomy and conservative treatment for the SF-36 physical function scores at 3 months, 6 months, 12 months and 24 months (P > 0.05) and two studies reported patients were satisfied with X-STOP implanted at six weeks, six months, and one year. No statistical differences for the adverse events intra-operation or within 72 h (P > 0.05) between surgery and non-surgery groups. Moreover, subgroup analysis showed there were no safety differences between laminectomy and conservative treatment, X-STOP and conservative treatment at early stage of duration. However, the surgical groups had higher complication rates than non-surgery groups throughout the follow-up duration."
Conclusion Surgery groups showed better late clinical outcomes after one year and higher complication rate throughout the follow-up duration, although it had no significant differences compared with conservative groups in the first six months post-treatment. However, there was no evidence that a definitive method could be firmly recommended to LSS patients. Further researches were needed to achieve high quality and credible results.
Another study in 2015 looked at spinal fusion outcomes versus non-surgical as well and this is what they found.
"RESULTS: Meta-analysis of 6 randomized controlled trials with a total of 889 patients revealed no difference in Oswestry Disability Index (ODI) score for DLBP between the fusion surgery and nonsurgical groups (mean difference, 1.94; 95% confidence interval [CI], -6.02 to 2.14). Postsurgical complication rate significantly differed between the 2 groups (risk ratio, 22.11; 95% CI, 55.99-81.60). CONCLUSIONS: Fusion surgery was not superior to nonsurgical treatment in terms of changes in ODI scores for DLBP. Fusion surgery resulted in surgical complications. Longer follow-up observation is necessary regarding condition-specific disability, pain, and life satisfaction."
With surgery comes complications that can arise on the table, or after the fact with regard to blood flow issues and clotting. Clots are serious and can potentially cause pulmonary embolisms in the lungs or aneurisms/strokes in the brain and heart. If you can avoid these unnecessary risks to have the same outcome with quality therapy, then it stands to reason why you would opt in - red flags aside.
We would love to setup a FREE Discovery visit with you - in person, no charge, where we discuss your specific conditions, complaints and how we can get you back to the things you love without pain.
Stay tuned for what to expect with regard to recovery from surgery. Will I need Physical Therapy? Will it hurt? Will I be able to do all the things I want? Will it help my pain and symptoms?
Dr. Jarred Tobin PT, DPT