Patients Recover Sooner from Minimally Invasive Back Surgeries

By Pat Anson, PNN Editor

A new study comparing short-term outcomes of minimally invasive lumbar decompression surgeries to minimally invasive spinal fusions found no significant difference in the amount of time patients needed to return to work. But decompression patients were able to drive and stop taking opioid pain medication sooner than the fusion patients.

Researchers at Hospital for Special Surgery (HSS) in New York City found that it took 117 decompression patients a median of three days to discontinue opioid medication, while it took a median of seven days for 51 spinal fusion patients.

It took 88 decompression patients a median of 14 days to resume driving, while it took 18 days for 45 fusion patients.

The findings are noteworthy, according to Sheeraz Qureshi, MD, an HHS spine surgeon, because a standard open spinal fusion generally entails a much longer recovery and slower return to activities than a standard lumbar decompression.

“Our study is the first of its kind to look at return to activities and discontinuation of narcotic pain medication after single-level lumbar decompression or single-level lumbar spine fusion performed with a minimally invasive technique,” said Qureshi, who was senior investigator for the study.

“All the patients in both groups were able to resume driving and return to work within three weeks of surgery. When you compare this time frame to that of standard open spinal fusion surgery, it’s really striking. Patients having a standard spinal fusion could take six months or longer for a full recovery.”

Degenerative conditions of the lumbar spine, such as a herniated disc or spinal stenosis, are common causes of chronic back pain. Patients may consider surgery when conservative treatments such as medication and physical therapy fail to provide relief.

Lumbar decompression surgery involves the removal of a small section of bone or part of a herniated or bulging disc that is pressing on a nerve. Spinal fusion is more extensive surgery, and is performed to stabilize and strengthen the spine. Surgeons join two or more vertebrae together, sometimes using screws and connecting rods.

In recent years, minimally invasive (MI) spine surgery has gained in acceptance and popularity. The technique uses smaller incisions than standard surgery and aims to minimize damage to nearby muscles and other tissues.

Although MI decompressions and MI fusions use the same initial approach to reach the spine with the same size incisions, the fusions are still more extensive surgeries, so pain medication may be needed for a longer period of time, according to Dr. Qureshi.

This study findings were presented at the annual meeting of the American Academy of Orthopaedic Surgeons.

Low Impact Exercise Reduces Pain in Seniors

By Pat Anson, Editor

Even a modest amount of exercise is effective at easing pain from arthritis, and other muscle and joint conditions in older adults, according to the latest study by the Hospital for Special Surgery (HSS) in New York City.

Since 2011, HHS has offered free, low-impact exercise programs at senior centers in Chinatown, Flushing, and Queens – and tracked the health of those who participated. Researchers presented their latest findings at the annual meeting of the American Public Health Association in Denver.

"Joints will often stiffen if not used, and muscles will weaken if not exercised. Our bodies are meant to move, and inactivity leads to weakness and stiffness, and joints with arthritis often worsen with inactivity," said Theodore Fields, MD, director of the Rheumatology Faculty Practice Plan at HSS.

The exercise program takes place once a week for eight weeks. Participants perform chair and floor mat exercises using stretch bands and other gentle exercises led by certified bilingual instructors.

The program was originally developed for Asian seniors 65 and older, many of whom live in poverty and suffer from arthritis and musculoskeletal conditions.

A survey was distributed to participants before classes began and after they ended to evaluate pain, physical function, stiffness, fatigue, balance and other health indicators. A total of 256 adults completed the questionnaires, the vast majority of them elderly women.

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"Overall, the program was very well-received," said Minlun (Demi) Wu, an HHS research coordinator. "After completing the classes, statistically significant differences were found in pain intensity, physical function, balance, and confidence about exercising without making symptoms worse."

Eight out of ten participants said they had less pain after participating in the program. Over 90 percent said they had less stiffness, fatigue and their balance improved. There was also significant improvement in their ability to perform daily activities, such as lifting or carrying groceries; climbing stairs; bending, kneeling and stooping; and bathing and getting dressed.

"The study results are consistent with the experience of rheumatologists and with prior studies showing that exercise, even of mild degree, helps with pain," said Dr. Fields. "Getting people up and moving does appear to help with mood, pain and overall functioning."

"Our findings indicate that implementing a bilingual low-impact exercise program can play an important role in pain relief, improved quality of life and improved levels of physical activity in the underserved Chinese community," said Wu, adding that the classes have become so popular there is a waiting list.

According to the CDC, Asian seniors have some of the highest rates of physical inactivity. Chinese Americans are also less likely to seek health care because of cost and language and cultural barriers.