Can spinal surgery be prevented by aggressive strengthening exercises? A prospective study of cervical and lumbar patients

Objective: To determine if patients recommended for spinal surgery can avoi d the surgery through an aggressive strengthening program. Setting: A privately owned clinic, staffed by physicians and physical thera pists, that provides 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 n o medical condition preventing exercise, and (3) were willing to participat e in the approximately 10-week outpatient program. Treatment consisted main ly of intensive, progressive resistance exercise of the isolated lumbar or cervical spine. Exercise was continued to failure, and patients were encour aged to work through their pain. Third-party payers in Minneapolis were sur veyed for average costs. Average follow-up occurred 16 months after dischar ge. Results: Forty-six of the 60 participants completed the program; 38 were av ailable for follow-up and three required surgery after completing the progr am. Discussion/Conclusions : Despite methodologic limitations, the results are intriguing. A large number of patients who had been told they needed surger y 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." (C) 1999 by the American Congress of Rehabil itation Medicine and the American Academy of Physical Medicine and Rehabili tation.