Another of my concerns with the authors’ conclusions regards the unfavorable comparison of normative data of pain score outcomes for medically treated patients reported in the Italian medical literature with the surgical patients in this study. First, the characteristics of these historical medical patients are unknown and the duration of their follow-up is unspecified. Second, while pain scores were lower in surgical patients versus the historical controls, physical function measures were comparable in both groups. Therefore, I would not consider the current study definitive in assessing the relative long-term benefits of medical versus surgical therapy.
Patients with herniated discs are interested in practical outcomes. They are concerned with pain relief, the preservation of function, and limiting future episodes of disc hernation and progressive spinal disease. A recent study by Weinstein et al. reports the equally favorable outcomes of medical and surgical therapy for herniated discs at two years.2 The study by Mariconda et al. demonstrates the potential of those individuals who choose surgery to have a continued good outcome a quarter of a century later.
Lymphoma Risk in Patients with Ankylosing Spondylitis
By David G. Borenstein, MD
Background: Several inflammatory conditions are associated with an increased risk of lymphoma. The specific features of inflammation that mediate this risk are unknown. There are few studies on whether ankylosing spondylitis (AS) increases the risk of lymphoma. Besides inflammation-lymphoma etiology, information on risk of lymphoma in ankylosing spondylitis is particularly important as a benchmark in the evaluation of, for example, TNF inhibitors.
Methods: The association between ankylosing spondylitis and malignant lymphomas overall (and separately for non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, and chronic lymphocytic leukemia) was assessed in a nationwide, population-based, case-control study of 50,615 cases of lymphoma and 92,928 matched controls by using prospectively recorded data on lymphomas from the Swedish Cancer Register (1964–2000) and data on pre-lymphoma hospitalizations for ankylosing spondylitis from the Swedish Inpatient Register (1964–2000). The odds ratios (ORs) associated with pre-lymphoma hospitalization for ankylosing spondylitis were calculated using conditional logistic regression.
Results: Twenty-three (0.05%) patients with lymphoma and 41 (0.05%) controls had a pre-lymphoma hospitalization listing ankylosing spondylitis, relative risk=1.0 (95% confidence interval [CI] 0.6 to 1.7). The number of discharges and the mean latency between ankylosing spondylitis and lymphoma were similar in patients and controls. Analyses restricted to lymphomas diagnosed during the 1990s showed similar results (OR=1.3, 95% CI 0.6 to 2.5, number of exposed cases/controls=14/21).