Fifty patients with lumbar spondylolisthesis, Fifty patients with stenosis, and Fifty patients with disc herniation who had symptoms persisting after 6 weeks of medical management and who were eligible for surgical treatment were followed after deciding on nonsurgical treatment.
The maximum health gain in back pain, leg pain, disability, quality of life, depression, and general health state did not achieve statistical significance by 2 years of medical management, except for pain and disability in patients with disc herniation and back pain in patients with lumbar stenosis.
Eighteen patients (36%) with spondylolisthesis, 11 (22%) with stenosis, and 17 (34%) with disc herniation eventually required surgical management due to lack of improvement.
The 2-year improvement did not achieve a minimum clinically important difference in any outcome measure. The mean 2-year total cost (direct plus indirect) of medical management was $6606 for spondylolisthesis, $7747 for stenosis, and $7097 for herniation.1
In all cases, comprehensive medical management included spinal steroid injections, physical therapy, muscle relaxants, antiinflammatory medication, and narcotic oral agents was not cost effective and the patients went on to surgery.
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1. Parker SL, Godil SS, Mendenhall SK, Zuckerman SL, Shau DN, McGirt MJ. Two-year comprehensive medical management of degenerative lumbar spine disease (lumbar spondylolisthesis, stenosis, or disc herniation): a value analysis of cost, pain, disability, and quality of life: clinical article.