In 2009, we discussed an article in the Journal of the American Academy of Orthopaedic Surgeons, which advised patients to try physical therapy before resorting to low back surgery for degenerative disc disease. Now, six years later, a University of Pittsburgh study found that surgery and physical therapy achieved roughly the same success rates for “lumbar spinal stenosis.”
Perhaps the first thing to address is what are “degenerative disc disease” (DDD) and “spinal stenosis.” As the name implies, degenerative disc disease is the damage, the wear and tear, that is caused just by years of activity. As with grey hair, bad eyesight or other physical traits, some people are more prone to this condition than others. “Spinal stenosis” is a narrowing of the spine, which can lead to a nerve being irritated. This can be caused by DDD or by another condition (scoliosis or arthritis, for example). A herniated disc can also cause the canal in which the nerves pass to become much narrower.
Why, then, would this topic be of interest to injured workers, you might ask. If this is a degenerative problem, then what could work have to do with it? As it turns out, work often has a great deal to do with it. Many people, some say the majority of a certain age, have these degenerative changes, but have no symptoms. Often, a work injury “aggravates” these degenerative changes, making something symptomatic which never was before. It is important to know that an aggravation of pre-existing condition, such as degenerative disc disease, is a “new injury” for workers’ compensation purposes. The work injury need not “cause” the disability; simply aggravating an already existing condition is enough. And that makes sense – after all, if you were able to do your job before the work injury, and then were no longer able to do your job after the work injury, shouldn’t you be compensated?
Back to the main topic, this new study continues to enforce what had been said in the past – lumbar surgery for these conditions should not be a primary response. The lead author of the recent article, Tony Delitto, chair of Pitt's physical therapy department, stated, “they should exhaust nonsurgical options, which include physical therapy, before they consent to surgery.” Certainly sounds like a reasonable way to proceed.