Chronic Low Back Pain: Surgery vs Physical Therapy
Chronic low back pain (CLBP) in the U.S. is arguably the epidemic of the century. Various lifestyle factors that are unique to the western world have caused a high percentage of sufferers that is not seen in other cultures. While there are numerous preventative measures for CLBP, the question remains. What is the best course of action once CLBP sets in? Surgery and physical therapy are probably the two most discussed options to address these symptoms. Cost effectiveness, time, and outcomes are extremely important factors when considering surgery versus physical therapy when treating CLBP.
Time and money are the most precious commodities we have. Perhaps the most common surgeries for CLBP are spinal decompressions and spinal fusions, depending on the individual diagnosis. National averages of spinal decompressions and spinal fusions are about $17,000 and $29,000 respectively.(1) This does not include recommended physical therapy costs post-surgery. Also, consider that most patients undergo eight to ten to twelve weeks of rest before even initiating an eight-week stint of post operative rehabilitation.(2) Physical therapy is objectively more time-efficient and cost-effective when compared to spinal surgery.
Next, surgical outcomes and physical therapy outcomes are basically the same for the treatment of CLBP. A score matched analysis study by Minetama determined that surgery “yielded similar results” to supervised physical therapy and suggested that “supervised physical therapy is preferred over surgery as first-choice treatment to prevent complications and minimize health care costs.”(3) A famous randomized control trial (which is considered to be an extremely high-quality form of evidence) by Delitto determined that there was no difference in change in function between physical therapy groups and surgical groups.(4) Further suggesting that differences in outcomes between rehab and surgery are often negligible.
One thing is for sure, shared decision making between health care providers and patients are absolutely essential. Due to high health care costs, extensive time, and uncertain outcomes, physical therapy treatment should always be considered first when contemplating the possibility of undergoing surgery for CLBP. If you have been suffering from CLBP, it doesn’t have to be that way. If you have activity or athletic goals that are inhibited by pain, seek help! The doctors at The PATH Rehab & Performance offer free 30-minute discovery calls where we can discuss symptoms, goals, and answer any questions and/or concerns you may have. Give performance-based physical therapy a try before more invasive procedures. Your time, wallet, and body will thank you.
References:
1. Poslusny C. How can you find a fair, affordable spinal surgery cost? New Choice Health Blog. https://www.newchoicehealth.com/spinal-surgery/cost. Published September 29, 2021. Accessed November 17, 2022.
2. Surgery for spondylolisthesis. Patient Care at NYU Langone Health. https://nyulangone.org/conditions/spondylolisthesis/treatments/surgeryforspondylolisthesis. Accessed November 17, 2022.
3. Minetama M, Kawakami M, Teraguchi M, et al. Supervised physical therapy versus surgery for patients with lumbar spinal stenosis: A propensity score-matched analysis. BMC Musculoskeletal Disorders. 2022;23(1). doi:10.1186/s12891-022-05632-y
4. Barrer SJ. Surgery versus nonsurgical treatment of lumbar spinal stenosis. Annals of Internal Medicine. 2015;163(5):396. doi:10.7326/l15-5129
Dr. Cody Benavides
PT, DPT, TPI cert
Co-owner | The PATH Rehab & Performance
