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More improvement seen with surgery than injections for degenerative lumbar disease

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SAN DIEGO —  Surgery was superior to epidural steroid injections for pain and quality of life improvements in patients with degenerative lumbar disease, according to a presenter at the Congress of Neurological Surgeons Annual Meeting.

“We all know there is a big spotlight on ineffective surgery and spine is at the forefront of that,” Ahilan Sivaganesan, MD, said during his presentation. “[ I] think tools like this [predictive model] that you can take into your clinic will help make sure that we provide the right therapy for the right patient and then, therefore, reduce costs and overall improve the value of spine care as a whole.”

Ahilan Sivaganesan

Sivaganesan and colleagues, in a prospective, matched cohort study, collected data on all patients at Vanderbilt University who underwent elective lumbar surgery for degenerative lumbar disease. Weekly, patients who opted for nonsurgical treatment with injections were placed into a separate parallel registry. Eighty-two patients were identified for the surgically treated group and 82 patients received epidural steroid injections.

Patient-reported outcomes (PROs) were collected at 3 months and 12 months. Investigators determined what preoperative variables were correlated with PROs using univariate analysis and then used that information for one-to-one matching across the two treatment groups.

Results showed at 3 months patients who underwent surgery were superior compared to patients treated with epidural steroid injections with regard to Oswestry Disability Index (ODI), quality of life based on the EuroQal-5D (EQ-5D) and back and leg pain scores. Sivaganesan noted surgery was superior to epidural steroid injections except for ODI results, at 12 months.  

“We then looked at the change score, not just the absolute score in any given time point, and again at 3 months, surgery was superior to injections across the board and at 12 months this was the case for back and leg pain, but not for ODI and not for EQ-5D,” he said.  “This is interesting information that tells you, on average, surgery is superior to injections on a whole set of patient-reported outcomes.” ‒ by Monica Jaramillo

Reference:

Sivaganesan A., et al. Paper #161. Presented at: Congress of Neurological Surgeons Annual Meeting; Sept. 24-28, 2016; San Diego.

Disclosures: Sivaganesan reports no relevant financial disclosures.