About a year ago an investigative journalist exposed the worrying trend of spinal surgery in the United States through CBS news. It got some attention.
It turned out that in the decade between 2001 and 2011 spinal fusion surgeries performed in the US sky rocketed by 70%. This may have been partially attributed to an increase in medical technology and an ageing population. Regardless, the increase was alarming and by the year 2014 the US was spending $12 billion and performing over 480,000 spinal surgeries annually. Yes, you read that correctly. That is over 1 300 spinal surgeries a day. A lot in anyone's book. (1)
So what are the statistics for Australia? A fairly robust study was published in 2009 in the Australian and New Zealand Journal of Surgery . The numbers follow the same trend as the US. In the period between 1996 and 2007 lumbar spinal surgery (mostly for lumbar spinal stenosis) increased 167%! "Woah" I hear you say. We beat the US at something! This is not something to be too proud of I'm afraid.
The take home message from this research was that there were disproportionate numbers of spinal surgeries being performed in the private sector, which they linked directly to private health insurance rebates. Why was this happening? You decide. (2)
Last week the Annals of Internal Medicine published a study showing that surgery for lumbar spinal stenosis was no more effective than manual therapy. There were some limitations to the study and it did acknowledge that some people do require surgery, which can be extremely effective for particular pathologies and neurological cases. Also, the study does not suggest that manual therapy is the answer to all pain associated with lumbar spinal stenosis but it is probably worth pursuing over costly surgery as the outcomes are often the same, if not better.(3)
There have been other randomised control trials (really high standard research) done comparing the effects of spinal surgery vs intensive rehabilitation for back pain, and spinal surgery vs cognitive behavioural therapy (a form of psychotherapy) for low back pain. Guess what? There was no difference in the outcomes for patients between the groups. (4) (5)
That leaves a bit of a confusing picture though. What do you do when presented with pain associated with lumbar spinal stenosis? In the first instance, short manual therapy treatment is by far the best course of action. Previous BLOG posts (see here) have looked at the importance of understanding your pain and being educated about the process of pain and recovery. Your Osteopath will always assess you appropriately and refer if there is anything that seems out of their scope of practice.