Greenwich Time—GREENWICH, CONN.—June 14, 2007
Frank P. Cammisa Jr., M.D., a town resident for eight years who works as chief of the spine service at Manhattan's Hospital for Special Surgery, collaborated with 17 other physicians on a clinical trial of degenerative spondylolisthesis, a back condition caused when a vertebra slips out of alignment.
"There's a significant advantage in surgery over nonsurgical care for patients," said Cammisa, 50, a spinal surgeon and father of three who has an Old Greenwich practice at 142 Sound Beach Ave. "This is really an anatomical problem, in terms of one vertebral body being displaced on another and causing pressure on the nerves, and by correcting that deformity, basically restoring a more normal anatomy, surgery gives an excellent outcome."
For two years, Cammisa helped follow 601 patients from 11 states who underwent either surgery or treatments such as physical therapy, steroid injections, simple weight loss and anti-inflammatory medication. The study, published last month in The New England Journal of Medicine, found that surgery to relieve pressure on the nerves was twice as effective as nonsurgical approaches in reducing pain and quickly restoring the ability to walk and otherwise function.
The study is among the first controlled trials to gauge the effectiveness of the back surgery by comparing it to nonsurgical options. It's part of the Spine Patient Outcomes Research Trial, a seven-year, $21 million initiative funded by the National Institutes of Health. In addition to degenerative spondylolisthesis, the initiative is conducting trials on ruptured discs and the narrowing of the spinal canal, known as spinal stenosis.
No one knows exactly how many people suffer from degenerative spondylolisthesis. Most common in women over the age of 50 and affecting six times more women than men, the condition can cause numbness, cramping or weakness in the legs and even bowel and bladder problems, according to the Dartmouth-Hitchcock Medical Center. The Lebanon, N.H., facility is one of 13 nationwide that participated in the study.
Caused simply by aging—though sometimes hereditary—and by changes in blood flow to the spine, spondylolisthesis can be excruciatingly painful and may effectively paralyze its victims.
Stratford resident Dolores Sanchione, 69, led an active life—including 35 years on a women's synchronized swimming team—before years of back problems culminated in degenerative spondylolisthesis in late 1999.
"It's awful. You have constant pain," said Sanchione. "It's almost intolerable. It never goes away, and then it starts to affect your legs. It's just very depressing because you've got to battle that pain, and you wake up and it's still there and doesn't leave."
Sanchione had tried physical therapy and chiropractors, but nothing helped until she joined the study and underwent a surgery that Cammisa performed in June 2001.
"It made all the difference," Sanchione said. "It changed my life."