Lumbar Fusion and Chronic Low Back Pain

Randomized, controlled trials

Brox JI, Sorensen R, Friis A, Nygaard O, Indahl A, Keller A, Ingebrigtsen T, Eriksen HR, Holm I, Koller AK, Riise R, Reikeras O. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine. 2003 Sep 1;28(17):1913-21. This prospective study looked at 64 patients with low back pain for longer than one year with radiographic evidence of disc degeneration at L4-L5? and/or L5-S1?. Patients were randomized to either the lumbar fusion with instrumentation group or the cognitive intervention with exercise group. There were no differences after one year between the two groups with respect to Oswestry Disability Index, improvement in back pain, use of analgesics, emotional distress, life satisfaction, and return to work. Fear avoidance beliefs and fingertip-floor distance were reduced more after non-operative treatment, while lower limb pain was reduced more after surgery.

Fritzell P, Hagg O, Wessberg P, Nordwall A; Swedish Lumbar Spine Study Group. 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine. 2001 Dec 1;26(23):2521-32; discussion 2532-4. This is a prospective study of 294 patients with chronic low back pain of at least two year duration and with radiographic evidence of disc degeneration at L4-5 and/or L5-S1?. The patients were radomized into a surgical lumbar fusion group and a non-surgical group to determine which group offered better outcomes. The surgical group included three different fusion techniques not analyzed separately. The non-surgical group was treated with non-standardized physical therapy. The improvement of pain and disability was statistically superior in the surgical fusion group as compared to the non-surgical group. The early complication rate of 17% in the surgical group was comparable to other studies.