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Category: Volume 06 Issue 05 May 2018
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Title: To Compare the Efficacy of Conservative Management with Surgery for Treatment of Chronic Low Back Pain: A Randomised Prospective Cohort Study

Authors: Dr Kuldeep Yadav, Dr Mamta Harjai

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.35

Abstract

Background: Low back pain is a common medical problem in general population with high morbidity and healthcare costs. The optimal management strategy, including the role of surgical intervention, remains controversial. We conducted a randomized prospective cohort study to compare the efficacy of surgery and conservative management for chronic low back pain.

Materials and Methods: This randomized prospective cohort study was conducted on 130 patients with low back pain. Patients were divided randomly into Group I (Conservative management) and Group II (surgical management). Follow up of patients was done at intervals of 1 week, 4 weeks, 3 months and then 6 month, 1 year and 2 years. Visual Analog Scale (VAS) was used for assessment of pain for all patients. Modified Mc Nab Scale was used as post operative/management tool to assess intensity of low back pain and quality of life.

Results: There was a gradual decline in VAS score for Group 1 till follow up whereas an early and sharp decrease in VAS scorewas seen for Group II till 3 months after which it increased on an average till last follow up. Mac Nab scale showed gradual improvement in condition of patients over a period of time for Group I with more patients showing improvement by 1 year. Mc Nab scale showed good results starting within first week only up to 3 months for Group II. Later there was some deterioration/static scores in group 2 perticularly, and patients were almost in same state at 2 years of follow up for both the groups.

Conclusion: A gradual improvement in condition occurs by conservative management for chronic low back pain. Surgical management provides immediate good results but in  some patients pain relief may not last for long period. More studies comparing the two treatment options can give better insight into the selection of treatment option for the patients with chronic low back pain and may validate our results.

Keywords: Conservative management, Low back pain, surgical management, Visual Analog Scale, Modified Mac Nab criteria.

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Corresponding Author

Dr Mamta Harjai

MBBS, MD, Associate Professor, Department of Anaesthesia, Dr. RMLIMS, Lucknow, UP India