Looking Back at Back Surgery
If you break a vertebra in your lower back, having screws surgically implanted into the broken bone is one way to relieve pain and correct the injury. But like any surgery, the procedure is expensive and can lead to other problems. Is surgery always the best choice?

To answer this question, researchers followed 80 patients with a fractured vertebra in the lower spine. None of the patients had nerve problems due to the fracture. Thirty-three of the patients had surgery shortly after their injuries. Surgeons put three screws in the spine--one at the level of the fracture, one above, and one below. The other 47 patients didn't have surgery. They were fitted with a special brace to wear at all times except when bathing. And they were encouraged to get up and move around unless the pain was too great.

At first, patients who had surgery seemed to do better than those who didn't. Patients in the surgery group reported less pain at one month and three months after the injury. They also showed better overall health in their backs for up to six months. However, after one year, patients in both groups were doing about the same. Surgery or not, less than half of the patients who did heavy work were able to get back to their original jobs.

In general, surgery is thought to allow patients to get up and move earlier and more safely, to keep the spine aligned better, and to prevent problems in the nerves near the fracture. But this study showed that patients who didn't have surgery were safe to get up and move right away and were free of nerve problems, too. Alignment of the bones wasn't as good as in those who had surgery, but this didn't seem to have an effect on peoples' pain or their ability to do activities. So the authors question whether the risks of surgery outweigh the added benefits for getting optimal alignment.

Patients who had surgery seemed less satisfied with their treatment two years later, possibly because they had higher hopes than those who didn't opt for surgery. Not surprisingly, there was a huge difference in the cost of treatment, with surgery costing four times more.

The authors conclude that although patients who have surgery for a fracture of this kind may recover more quickly, the difference between having surgery or not disappears after a year. As always, the choice to have surgery needs to be weighed against the risks.
Wun-Jer Shen, MD, et al. Nonoperative Treatment Versus Posterior Fixation for Thoracolumbar Junction Burst Fractures Without Neurological Deficit. In Spine. May 1, 2001. Vol. 26. No. 9. Pp. 1038-1045.