Surgery no better than PT for Lumbar Spinal Stenosis

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DrCommonSense

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http://annals.org/aim/article/22141...tment-lumbar-spinal-stenosis-randomized-trial

Once again, another internal medicine journal rips to shreds back surgery as "no better than PT" after 24 months for "LSS".

Whose telling the truth?

However, another study from JAMA shows that PT doesn't have "clinically significant improvement compared to baseline" for treating back problems either:

https://www.sciencedaily.com/releases/2015/10/151013133412.htm

Maybe we should just give everyone Ibuprofen and tell them to STFU and get lost?

Chou and Deyo might do some acupuncture on them too?
 
DrCommonSense said:
http://annals.org/aim/article/22141...tment-lumbar-spinal-stenosis-randomized-trial

Once again, another internal medicine journal rips to shreds back surgery as "no better than PT" after 24 months for "LSS".

Whose telling the truth?

However, another study from JAMA shows that PT doesn't have "clinically significant improvement compared to baseline" for treating back problems either:

https://www.sciencedaily.com/releases/2015/10/151013133412.htm

Maybe we should just give everyone Ibuprofen and tell them to STFU and get lost?

Chou and Deyo might do some acupuncture on them too?
Click to expand...
You're comparing apples to oranges (as I'm sure you know).

Why would anyone expect a significant difference between PT and usual care beyond 3 months? Acute onset LBP without radicular symptoms is quite often a self limiting condition. It's the role of PT (in my opinion) to see a patient for 2-4 visits to speed up the process that would likely happen anyway.
 
jesspt said:
You're comparing apples to oranges (as I'm sure you know).

Why would anyone expect a significant difference between PT and usual care beyond 3 months? Acute onset LBP without radicular symptoms is quite often a self limiting condition. It's the role of PT (in my opinion) to see a patient for 2-4 visits to speed up the process that would likely happen anyway.
Click to expand...

The article is clearly for Lumbar Spinal Stenosis not acute random LBP.

Read the study and come back to me.
 
pmrmd said:
That sorry excuse for a study was the worst thing I've read in a while.
Click to expand...

Yeah but it was published in A TOP level medicine journal that is considered on par with NEJM. Kind've interesting huh?
 
kind of a waste of an article.

no control.
subjects were from 2000-2007. why was there an 8 year wait between collecting data and presenting article? a few years, i understand. but almost a decade? and some of the data would be from 15 years between surgery and publication.

the "researchers" were primarily PT, not physicians. ? skewed?

in one of the letters, it is interesting to point out that 2/3 of patients asked to participate in the study declined. that is a huge number suggesting bias.


this article was published a year ago. old news. only arena it will have any effect is, well on some unheard of pain forum...
 
DrCommonSense said:
Yeah but it was published in A TOP level medicine journal that is considered on par with NEJM. Kind've interesting huh?
Click to expand...

annals of internal medicine is considered a decent journal, but it's not considered on par with NEJM. only NEJM is NEJM.

That's like saying a Miata is on par with a Ferrari. Both are sports cars, but one is clearly better.
 
Ducttape said:
kind of a waste of an article.

no control.
subjects were from 2000-2007. why was there an 8 year wait between collecting data and presenting article? a few years, i understand. but almost a decade? and some of the data would be from 15 years between surgery and publication.

the "researchers" were primarily PT, not physicians. ? skewed?

in one of the letters, it is interesting to point out that 2/3 of patients asked to participate in the study declined. that is a huge number suggesting bias.


this article was published a year ago. old news. only arena it will have any effect is, well on some unheard of pain forum...
Click to expand...

I understand all the arguments that are you making being valid.

But the question that occurs is: Why did they publish this article in a TOP medical journal then? Sounds like another attack on procedural medicine.
 
possibly, or possibly an attempt for the PT industry to boost their own standing.

or it might have been an attempt to temper any change in attitude that the SPORT trial 4 year outcomes study that came out in 2010-11, and falls in line with the 8 year outcomes study published in 2015.
(which said, btw:
As-treated analyses in the randomized group showed that the early benefit for surgery out to 4 years converged over time, with no significant treatment effect of surgery seen in years 6 to 8 for any of the primary outcomes. In contrast, the observational group showed a stable advantage for surgery in all outcomes between years 5 and 8.
Click to expand...
 
SPORT trial has a lot of pro surgical bias. The ortho spine surgeons from my last group used to walk around quoting it everywhere they went and also went on their facebook page and smeared injections and quoted sport
 
DrCommonSense said:
http://annals.org/aim/article/22141...tment-lumbar-spinal-stenosis-randomized-trial

Once again, another internal medicine journal rips to shreds back surgery as "no better than PT" after 24 months for "LSS".

Whose telling the truth?

However, another study from JAMA shows that PT doesn't have "clinically significant improvement compared to baseline" for treating back problems either:

https://www.sciencedaily.com/releases/2015/10/151013133412.htm

Maybe we should just give everyone Ibuprofen and tell them to STFU and get lost?

Chou and Deyo might do some acupuncture on them too?
Click to expand...

This is easy. No neuro deficits / claudication, no surgery.
It's not the worst thing in the world to tell some pain pts to STFU in a loving kind way. This is essentially CBT. How did millennia of humans survive with CLBP and / or stenosis before fusions and IPM and opioids? These are first world problems.
 
Last edited:
nolapsych said:
This is easy. No neuro deficits / claudication, no surgery.
It's not the worst thing in the world to tell some pain pts to STFU in a loving kind way. This is essentially CBT. How did millennia of humans survive with CLBP and / or stenosis before fusions and IPM and opioids? These are first world problems.
Click to expand...

Humans "survived" millennia without CABGs, Stents, Prostate Surgeries, Knee Arthroscopic Surgery, Rotator Cuff surgeries, etc as well. We can just get rid of all of that stuff too.
 
Dr. Ice said:
SPORT trial has a lot of pro surgical bias. The ortho spine surgeons from my last group used to walk around quoting it everywhere they went and also went on their facebook page and smeared injections and quoted sport
Click to expand...

Correct.

Also, they forget to mention that consistent laminectomy surgeries cause instability in patient's whereby the level above/below start "going bad" whereby they often get a fusion within a few years that necessitates hardware going down that cascade effect that ultimately leads to high dosages of narcotics.
 
Ducttape said:
possibly, or possibly an attempt for the PT industry to boost their own standing.

or it might have been an attempt to temper any change in attitude that the SPORT trial 4 year outcomes study that came out in 2010-11, and falls in line with the 8 year outcomes study published in 2015.
(which said, btw:
Click to expand...

On the other hand, internal medicine journals seem to be on a rampage against procedural medicine with almost no studies showing ANY procedures being valuable except for a very small select group.
 
DrCommonSense said:
The article is clearly for Lumbar Spinal Stenosis not acute random LBP.

Read the study and come back to me.
Click to expand...

You listed 2 studies, one referring to stenosis and the other the local LBP. Hence my apples to oranges response.
 
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