Vitamin D Levels, Absorption and Lower
Back Pain in Failed Surgery Patients

In a small study of nine patients with failed back surgery outcomes caused by either disc degeneration or spondylolisthesis, the author compared them with seven age and diagnosis matched controls who responded to conservative care, did not require surgery and were not in chronic pain. When the researchers tested vitamin D, they discovered the mean serum 25-hydroxy-calciferol levels in the 9 failed surgery patients was 17.9 ng/ml compared to 40.6 ng/ml in the 7 controls who responded to conservative care and were no longer in pain.

The Visual Analog Scale (VAS) was used to score pain. Vitamin D replacement was given to the nine patients in two 3 month stages separated by retesting. Stage 1 was ten days at 20,000 IU of vitamin D2 followed by eighty days of 600 IU of vitamin D3. Stage two was 600 IU of vitamin D3 for ninety days at which time serum levels were tested for a third time. See table 1.

Table 1:

Subjects 1-3 had degenerative disc disease; subjects 4-9 had spondylolisthesis
VAS - Visual Analog Scale

In this small study, higher vitamin D levels were associated with lower pain scores. See table 2.

Table 2:

The ability to absorb vitamin D2 and D3 differs widely from person to person. This small study provides an excellent example that there is no ‘one dose fits all’ approach when treating vitamin D deficiency. See table 3

Table 3:

There is general agreement on what constitutes low and deficient levels of vitamin D on a blood test. There is ongoing debate regarding adequate, normal, optimal, elevated and excessive levels. Hopefully these grey zones will be resolved by the research generated by increased interest (in vitamin D) that is currently underway. Even when the normal laboratory levels are better established, the best providers will not make the mistake of treating a test result while ignoring symptoms, complaints, history and exam findings.

Table 4:
Serum 25-hydroxycholecalciferol aka 25-hydroxyvitamin D3. aka 25(OH) D

References:
Waikaaul, S.
“Serum 25-Hydroxy-Calciferol Levels and Failed Back Surgery Syndrome”
Journal of Orthopedic Surgery 2012; 20 (1:18-22)

G. Douglas Andersen, D.C., C.C.N.

NOTE to Editorial: The text box above– Vitamin D in Supplements and Circulation – is a sidebar to the article and is not intended to be published at the end of the article.