Spinal surgery improves leg pain more than low back pain, and people with diabetes tend to experience less relief from spinal surgery than do those without diabetes. These are two of the most recent key findings of the Spine Patient Outcomes Research Trial (SPORT), the first comprehensive study to look at the effectiveness of different treatments for low back pain and pain that radiates down a patient’s leg.
The first of the two new studies, both of which were published in the journal Spine, involved two groups of patients — 615 with spinal stenosis, narrowing of the space that surrounds the spinal cord, and 591 with degenerative spondylolisthesis, a condition in which one of the vertebrae slips out of position onto the vertebra beneath it. Among the patients with spinal stenosis, 32 percent were bothered mostly by leg pain at the first examination; 26 percent were bothered primarily by back pain; and 42 percent had leg and back pain equally. Among the degenerative spondylolisthesis patients, 34 percent had predominant leg pain, 26 percent had predominant low back pain, and 40 percent had equal pain in the leg and low back. Sixty-two percent of patients with each diagnosis underwent surgery.
At one and two years after surgery, patients with predominant leg pain had improved significantly more than the low back pain groups; however, patients with low back pain improved significantly more than those who had not had surgery, suggesting that surgery can help both sources of pain, but offers more relief from leg pain.
The second study compared baseline characteristics and outcomes of 199 patients with diabetes with those of 2,206 people without diabetes who were enrolled in SPORT for the treatment of intervertebral disc herniation (the rupture of one of the discs of connective tissue that separate the vertebrae), spinal stenosis, or degenerative spondylolisthesis. The patients with diabetes, who tended to be significantly older and more likely to be overweight or obese than those without diabetes, did not improve as much as those without diabetes following surgery. In fact, surgery for intervertebral disc herniation did not seem to benefit patients with diabetes any more than non-operative treatments did. Furthermore, the older patients with diabetes were more likely to have surgical complications than patients without diabetes.
For patients with diabetes who are considering spine surgery, these findings suggest that the risks of surgery may not be worth the benefits. Fortunately, SPORT has shown non-operative treatments are beneficial, regardless of whether a patient has diabetes.
Supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), SPORT was designed to provide evidence to guide doctors and their patients in their treatment choices for common spinal conditions.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS website at http://www.niams.nih.gov.
The impact of diabetes on the outcomes of surgical and nonsurgical treatment of patients in the spine patient outcomes research trial. Freedman MK, Hilibrand AS, Blood EA, Zhao W, Albert TJ, Vaccaro AR, Oleson CV, Morgan TS, Weinstein JN. Spine. 2011 Feb 15;36(4):290-307. PMID: 21270715
Predominant leg pain is associated with better surgical outcomes in degenerative spondylolisthesis and spinal stenosis: results from the Spine Patient Outcomes Research Trial (SPORT). Pearson A, Blood E, Lurie J, Abdu W, Sengupta D, Frymoyer JW, Weinstein J. Spine. 2011 Feb 1;36(3):219-29. PMID: 21124260