We performed a meta-analysis of randomised controlled trials to investigate the effectiveness of surgical fusion for the treatment of chronic low back pain compared to non-surgical intervention. Several electronic databases (MEDLINE, EMBASE, CINAHL and Science Citation Index) were searched from 1966 to 2005. The meta-analysis comparison was based on the mean difference in Oswestry Disability Index (ODI) change from baseline to the specified follow-up of patients undergoing surgical versus non-surgical treatment. Of the 58 articles identified, three studies were eligible for primary analysis and one study for sensitivity analysis, with a total of 634 patients. The pooled mean difference in ODI between the surgical and non-surgical groups was in favour of surgery (mean difference of ODI: 4.13, 95%CI: -0.82 to 9.08, p = 0.10, I(2) = 44.4%). Surgical treatment was associated with a 16% pooled rate of early complication (95%CI: 12-20, I(2) = 0%). Surgical fusion for chronic low back pain favoured a marginal improvement in the ODI compared to non-surgical intervention. This difference in ODI was not statistically significant and is of minimal clinical importance. Surgery was found to be associated with a significant risk of complications. Therefore, the cumulative evidence at the present time does not support routine surgical fusion for the treatment of chronic low back pain.
Méta-analyse randomisée pour étudier la réalité de la fusion chirurgicale pour lombalgies chroniques comparée à l’évolution sans chirurgie. Plusieurs fichiers électroniques (Medline, Embase, Cinahl et Science citation index) ont été étudié de 1996 à 2005. La comparaison était basée sur les modifications de l’index d’Owestry (ODI) après traitement chirurgical ou non chirurgical. Trois études sur 58 articles étaient utilisables pour une première analyse et une étude pour une analyse fine, avec un total de 634 patients. Les différences de l’index mesuré étaient en faveur de la chirugie (différence moyenne de l’index ODI: 4,13; IC de 95%: −0,82 à 9,08; p = 0,10; I2 = 44,4%). Le traitement chirurgical s’accompagnait de 16% de complications précoces (IC de 95%:12–20%, I2 = 0%). La fusion chirugicale pour lombalgies chroniques améliore de façon non significative l’index de Oswestry par rapport au traitement non chirurgical et elle a un risque plus grand de complications.