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Pitt study: Therapy often can alleviate back pain as well as surgery

| Monday, April 6, 2015, 11:36 p.m.

Thousands of older adults with aching backs and legs might be able to avoid costly inpatient surgery that doctors have trusted for decades, a University of Pittsburgh study shows.

An estimated 400,000 Americans endure lower back, leg and other pain from lumbar spinal stenosis, according to the American Association of Neurological Surgeons. The condition narrows the spinal passages that house key nerves, at times making it painful to walk, said Anthony Delitto, the Department of Physical Therapy chairman at the Pitt School of Health and Rehabilitation Sciences.

While doctors at times recommend decompression surgery for the ailment, Delitto's findings, released Monday, suggest physical therapy works just as well in a large portion of cases — and at a fraction of the expense.

“It's clear that patients do not exhaust their non-surgical options before consenting to surgery. We think they should because physical therapy is one of those non-surgical options,” Delitto said.

He was the principal investigator for the study, results from which appear in Annals of Internal Medicine.

At least seven other researchers worked on the two-year project, which followed 169 patients at UPMC facilities in Oakland and Allegheny General Hospital in the North Side. All the participants were at least 50 years old and had been bound for decompression surgery.

The operation averages $24,000 nationwide and can keep patients hospitalized for two to three days. Delitto said the approach probably pre-dates the 1970s and accounts for about 100 surgeries each year per 100,000 Medicare enrollees who are 65 or older.

That amounts to about 40,000 operations a year, based on federal data.

In the Pitt study, about 43 percent of the surgery-bound patients enjoyed similar recoveries — and avoided the operation for at least two years — by going to specialized physical therapy instead.

Medicare lists the average fee at $1,440 for 12 sessions of the physical therapy, which Delitto said can carry fewer risks than operations. He said some patients reported surgery would be cheaper than physical therapy — in out-of-pocket expenses — under their insurance policies.

That difference “is significant for people on fixed incomes,” and could encourage them to choose surgery over physical therapy, Delitto said. Support for his work came from the National Institutes of Health and the National Institute of Arthritis and Musculosketal and Skin Diseases.

Research participant Stephanie Paul, who enrolled in a separate Pitt study, called physical therapy a blessing as she battled lumbar spinal stenosis. She didn't want to face surgery.

“The days I come back from my exercises, it's been a full day. It's a real workout. But I feel good. I don't feel exhausted. I don't feel wiped out,” said Paul, 74, of Baldwin. “I feel as though I can do whatever I need to do. The energy is just boundless.”

Adam Smeltz is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or asmeltz@tribweb.com.

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