Sohail K Mirza1, Richard A Deyo. 1. Center for Cost and Outcomes Research, and Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA 98104-2499, USA. mirza@u.washington.edu
Abstract
STUDY DESIGN: Systematic review of randomized trials comparing surgical to nonsurgical treatment of discogenic back pain. OBJECTIVE: Compare research methods and results. SUMMARY OF BACKGROUND DATA: Recent reports have increased debate about the role of surgery in the treatment of chronic back pain associated with lumbar disc degeneration. We conducted a systematic review of randomized trials comparing lumbar fusion surgery to nonsurgical treatment of chronic back pain associated with lumbar disc degeneration. METHODS: A literature search identified 5 randomized trials that compared fusion to nonoperative treatment for chronic low back pain. Excluding 1 trial for spondylolisthesis, we compared study participants, interventions, analyses, and outcomes in 4 trials that focused on nonspecific chronic back. RESULTS: All trials enrolled similar subjects. One study suggested greater improvement in back-specific disability for fusion compared to unstructured nonoperative care at 2 years, but the trial did not report data according to intent-to-treat principles. Three trials suggested no substantial difference in disability scores at 1-year and 2-years when fusion was compared to a 3-week cognitive-behavior treatment addressing fears about back injury. However, 2 of these trials were underpowered to identify clinically important differences. The third trial had high rates of cross-over (>20% for each treatment) and loss to follow-up (20%); it is unclear how these affected results. CONCLUSIONS: Surgery may be more efficacious than unstructured nonsurgical care for chronic back pain but may not be more efficacious than structured cognitive-behavior therapy. Methodological limitations of the randomized trials prevent firm conclusions.
STUDY DESIGN: Systematic review of randomized trials comparing surgical to nonsurgical treatment of discogenic back pain. OBJECTIVE: Compare research methods and results. SUMMARY OF BACKGROUND DATA: Recent reports have increased debate about the role of surgery in the treatment of chronic back pain associated with lumbar disc degeneration. We conducted a systematic review of randomized trials comparing lumbar fusion surgery to nonsurgical treatment of chronic back pain associated with lumbar disc degeneration. METHODS: A literature search identified 5 randomized trials that compared fusion to nonoperative treatment for chronic low back pain. Excluding 1 trial for spondylolisthesis, we compared study participants, interventions, analyses, and outcomes in 4 trials that focused on nonspecific chronic back. RESULTS: All trials enrolled similar subjects. One study suggested greater improvement in back-specific disability for fusion compared to unstructured nonoperative care at 2 years, but the trial did not report data according to intent-to-treat principles. Three trials suggested no substantial difference in disability scores at 1-year and 2-years when fusion was compared to a 3-week cognitive-behavior treatment addressing fears about back injury. However, 2 of these trials were underpowered to identify clinically important differences. The third trial had high rates of cross-over (>20% for each treatment) and loss to follow-up (20%); it is unclear how these affected results. CONCLUSIONS: Surgery may be more efficacious than unstructured nonsurgical care for chronic back pain but may not be more efficacious than structured cognitive-behavior therapy. Methodological limitations of the randomized trials prevent firm conclusions.
Authors: Miranda L van Hooff; Johannes D van der Merwe; John O'Dowd; Paul W Pavlov; Maarten Spruit; Marinus de Kleuver; Jacques van Limbeek Journal: Eur Spine J Date: 2010-05-27 Impact factor: 3.134
Authors: Brook I Martin; Gary M Franklin; Richard A Deyo; Thomas M Wickizer; Jonathan D Lurie; Sohail K Mirza Journal: Spine J Date: 2013-11-07 Impact factor: 4.166