Chronic Back Pain: Surgery Or Conservative Treatment?

By http://en.wikipedia.org/wiki/user:Vsion - Originally Vsion's work, CC0, https://commons.wikimedia.org/w/index.php?curid=16090144

Should you have surgery or nonsurgical treatment for chronic lower back pain? This paper suggests nonsurgical treatment can be “effective, feasible, and safe” although more studies, properly conducted, are required to give more definitive results (a caveat one often reads with respect to such studies and reviews). Conclusions from the abstract:

CONCLUSIONS: For chronic low back pain, nonsurgical treatment was shown to be effective, feasible, and safe during the follow-up period. More randomized controlled trials are needed to compare surgical and nonsurgical treatment of chronic low back pain.

Here is a paper on lumbar spinal stenosis treatment, conclusions of the abstract:

AUTHORS' CONCLUSIONS: We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment. No clear benefits were observed with surgery versus non-surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects. High-quality research is needed to compare surgical versus conservative care for individuals with lumbar spinal stenosis.

Essentially, these authors state that there is no clear evidence of whether surgery or more conservative treatment is best for lumbar spinal stenosis; however, given that there is a significant risk of side effects for surgery and no side effects reported for conservative treatments, clinicians need to take care in how they inform patients of treatment options. Everyone must make their own decisions on these matters with the consultation of their physician. Speaking strictly for myself (as someone who has had some moderate flare-ups of lower back pain), I would always first choose the conservative treatments and have surgery as a “last resort’ back-up plan. But, that’s me. Others may be in a condition where conservative treatment does not help and then they and their physician need to review more aggressive treatment options.

Organ Transplants And Colorectal Cancer Risk

An interesting study.

Solid organ transplant recipients have increased colorectal cancer (CRC) risk. We assessed CRC risk among transplant recipients and identified factors contributing to this association. The US transplant registry was linked to 15 population-based cancer registries (1987-2010). We compared CRC risk in recipients to the general population by using standardized incidence ratios (SIRs) and identified CRC risk factors by using Poisson regression. Based on 790 cases of CRC among 224 098 transplant recipients, the recipients had elevated CRC risk (SIR 1.12, 95% confidence interval [CI] 1.04 to 1.20). The increase was driven by an excess of proximal colon cancer (SIR 1.69, 95% CI 1.53 to 1.87), while distal colon cancer was not increased (SIR 0.93, 95% CI 0.80 to 1.07), and rectal cancer was reduced (SIR 0.64, 95% CI 0.54 to 0.76). In multivariate analyses, CRC was increased markedly in lung recipients with cystic fibrosis (incidence rate ratio [IRR] 12.3, 95% CI 6.94 to 21.9, vs. kidney recipients). Liver recipients with primary sclerosing cholangitis and inflammatory bowel disease also had elevated CRC risk (IRR 5.32, 95% CI 3.73 to 7.58). Maintenance therapy with cyclosporine and azathioprine was associated with proximal colon cancer (IRR 1.53, 95% CI 1.05 to 2.23). Incidence was not elevated in a subgroup of kidney recipients treated with tacrolimus and mycophenolate mofetil, pointing to the relevance of the identified risk factors. Transplant recipients have increased proximal colon cancer risk, likely related to underlying medical conditions (cystic fibrosis and primary sclerosing cholangitis) and specific immunosuppressive regimen

Therefore, certain organ transplant patients have an increased risk of proximal colon cancer dependent upon certain comorbidities as well as the type of immunosuppressant(s) they are taking to maintain their transplant and prevent rejection.

Robotic Surgery Option for Colorectal Cancer

Advanced robotic options for colorectal cancer surgery are becoming available and require more study. Abstract:

Robotic surgery, used generally for colorectal cancer, has the advantages of a three-dimensional surgical view, steadiness, and seven degrees of robotic arms. However, there are disadvantages, such as a decreased sense of touch, extra time needed to dock the robotic cart, and high cost. Robotic surgery is performed using various techniques, with or without laparoscopic surgery. Because the results of this approach are reported to be similar to or less favorable than those of laparoscopic surgery, the learning curve for robotic colorectal surgery remains controversial. However, according to short- and long-term oncologic outcomes, robotic colorectal surgery is feasible and safe compared with conventional surgery. Advanced technologies in robotic surgery have resulted in favorable intraoperative and perioperative clinical outcomes as well as functional outcomes. As the technical advances in robotic surgery improve surgical performance as well as outcomes, it increasingly is being regarded as a treatment option for colorectal surgery. However, a multicenter, randomized clinical trial is needed to validate this approach.