Abstract
BackgroundLow back pain is a very common disorder. In this field chronic low back pain represents a special challenge. The management of chronic low back pain consists of a range of different intervention strategies. Usually operative intervention should be avoided if possible. However, there are constellations were surgical therapy in patients with chronic low back pain seems to be meaningful.The aim of this study was to investigate the clinical outcomes after spine surgery and hip replacement in patients with chronic low back pain after undergoing a structured rehabilitation program including cognitive – behavioral therapy.MethodsFrom January 1, 2007 to January 1, 2010 patients were indicated for total hip replacement (THA) or spine surgery after receiving inpatient multidisciplinary pain programs including cognitive – behavioral therapy at our orthopedic institute with a specialized unit for the rehabilitation of chronic pain patients. Indications for surgery were based on the synopsis of clinical and imaging findings and on positive effects after local injections during the multidisciplinary pain program. The tools for assessment included follow-up at 6 and 12 months and analyses of pain, chronicity, physical functioning and depression.ResultsOf the 256 patients admitted for multidisciplinary pain program, fifteen were indicated to benefit from a surgical intervention during multidisciplinary pain program. Ten patients received spine surgery. THA was indicated in five patients. In all cases, the peri- and postoperative clinical courses were uneventful. Only two of the patients subjected to spine surgery and three patients who had THA were improved after 12 months. One patient reported a worsened condition. All patients presented with good functional outcomes and normal radiological findings.ConclusionsThe indication for surgical intervention in patients with chronic low back pain and degenerative diseases must be critically assessed. THA in this cohort should focus on functional aspects, such as the improvement of range of motion, rather than the reduction of pain. Spine surgery in chronic low back pain patients after multidisciplinary pain program including cognitive – behavioral therapy cannot be recommended due to its questionable success.
Highlights
Low back pain is a very common disorder
The surgical strategy consisted of interlaminar decompression, resection of the degenerated intervertebral disc and intervertebral fusion using a TLIF approach with the implantation of a titanium cage with autologous bone grafting, completed by posterior pedicle screw-rod instrumentation
Multidisciplinary pain programs were not developed to serve as diagnostic tools for surgical intervention, for patients suffering from chronic low back or mixed pain
Summary
Low back pain is a very common disorder. The management of chronic low back pain consists of a range of different intervention strategies. There are constellations were surgical therapy in patients with chronic low back pain seems to be meaningful. The aim of this study was to investigate the clinical outcomes after spine surgery and hip replacement in patients with chronic low back pain after undergoing a structured rehabilitation program including cognitive – behavioral therapy. Patients with chronic low back pain constitute an increasing challenge for every professional who treats spinal disorders. The management of chronic low back pain consists of a range of different intervention strategies, including physical therapy, occupational therapy, surgery, and pharmacological treatment, along with adjunctive treatment modalities, such as epidural steroid injections, acupuncture, and other alterative medical therapies [6,7,8]
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