CAN FUSION OR DISC REPLACEMENT FOR BACK PAIN DO BETTER? THE IMPACT UPON WORK AND OUTCOME MEASURES OF A FUCTIONAL RESTORATION

Abstract

Purpose: To establish the results of a three week functional restoration program in terms of commonly used surgical outcome measures

Method: 135 patients ( 57 male 78 female) undertook a three week functional restoration program consisting of hydrotherapy, gymnasium work, education and cognitive behavioral therapy. They completed pre-program standard questionnaires including the Oswestry Disability Index and the Roland Morris. Follow up was at an average of 26 months (std dev 7) The patient global assessment of worse, unchanged, better and much better were completed as well as the pre-program outcome measures.

Results: Oswestry; Roland Morris

Pre program 34 average: s.d. 158.8; s.d. 4.5

Post program 19 average: s.d. 174.3; s.d. 4.8

Patient Global assessment:

Much better 64; 47%

Excellent 62; 49.6%

Better: 52; 38%

Good: 43; 34.4%

Unchanged: 2; 9%

Fair: 16 ; 2.8%

Worse: 7; 5%

Poor: 4; 3.2%

Data on the impact upon work was available for 121 of the patients. Pre program 71 of the 121 had been seriously affected in the workplace. Work follow up was 79% and at follow up only 22 out of 96 were seriously affected in the workplace. A significant improvement.

43 had an injury at work, RTA or similar significant event, 89 did not. The ODI improved by 18 points in the attributable event group and 13 in the non event group. Similar results were found for the Roland score. There was no significant difference between the two groups.

Conclusion: A very favourable results in the treatment of chronic back pain can be achieved, despite including adverse patient groups. Over 80% of patients were in the ‘success’ treatment groups at follow up using the Scandinavian Spine stabilization study group global assessment tool. Surgeons, patients and health care purchasers need to be aware of what can occur with non surgical treatment.