May 30, 2007 (Insidermedicine) People with lumbar degenerative spondylolisthesis who are treated surgically experience substantially better pain relief and gain of function than those who are treated without surgery, according to a study published in the latest issue of The New England Journal of Medicine. 

Degenerative spondylolisthesis, the slippage of one lumbar vertebra over its neighbour, is typically treated using surgery. However, whether surgery is the best course is not clear; as studies looking at its outcomes versus conventional treatment have not separately considered different types of back injury.  

As part of the Spine Patient Outcomes Research Trial (SPORT), over 600 patients throughout the United States confirmed to have degenerative spondylolisthesis were almost equally divided into two groups. In the first group, patients were assigned to either surgical treatment or various nonsurgical therapies determined by the physician and patient. Patients from the second group were not specifically assigned to either treatment, but were observed to determine the frequency of surgery and nonsurgery.  

Both groups were similar in terms of their ailments at the beginning of the study, which allowed a more accurate evaluation of the consequences of surgery and conventional treatment. Body pain, physical function and longer-term disability were assessed using tried and true surveys, scoring systems, and statistical tests. 

In the first group, almost half of those assigned to initially receive conventional treatment went on to have surgery within two years. In the observational group, almost two-thirds chose surgery; of the rest who opted for conservative treatment, one-quarter subsequently had surgery within two years. 

While both routes had no long-term damage, surgery was clearly superior in terms of pain relief and restored mobility at three months and one year. Even two years later, those who received surgery were substantially better off than those treated conventionally. 

Intriguingly, the benefits of surgery were less pronounced for less-educated people. Whether or not this was a "chance finding" is unclear. Still, for those with degenerative spondylolisthesis, the surgical knife is preferred to conventional therapy. 

Reporting for Insidermedicine, I’m Dr. Petra Joller.