B. Nelson, D. Carpenter, T. Dreisinger, M. Mitchell, E. O'Reilly, C. Kelly, J. Wegner, A. Coulter, J. Palen, and M. Hogan. Archives of Physical Medicine and Rehabilitation 80:20-25, 1999.


Objective: To determine if patients recommended for spinal surgery can avoid the surgery through an aggressive strengthening program.

Setting: A privately owned clinic, staffed by physicians and physical therapists, that provide treatment for patients with neck and/or back pain.

Methods: Over a period of 2 1/2 years, consecutive patients referred to the clinic for evaluation and treatment were enrolled in the study if they (1) had a physician's recommendation for lumbar or cervical surgery, (2) had no medical condition preventing exercise, and (3) were willing to participate in the approximately 10-week outpatient program. Treatment consisted mainly of intensive, progressive resistance exercise of the isolated lumbar or cervical spine. Exercise was continued to failure, and patients were encouraged to work through their pain. Third-party payors in Minneapolis were surveyed of average costs. Average follow-up occurred 16 months after discharge.

Results: Forty-six of the 60 participants completed the program. At an average of 16 months after completion, 38 patients were available for follow-up while 8 patients could not be located or contacted. Of these 38 patients only three required surgery after completing the program.

Discussion/Conclusions: Despite methodologic limitation, the results are intriguing. A large number of patients who had been told they needed surgery were able to avoid surgery in the short term by aggressive strengthening exercise. This study suggests the need to define precisely what constitutes "adequate conservative care."

©1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation