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Ann Rheum Dis. 2010 Sep;69(9):1643-8. doi: 10.1136/ard.2009.108902. Epub 2009 Jul 26.

Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain.

Author information

1
Orthopaedic Department, Oslo University Hospital-Rikshospitalet, Sognsvannsveien, 0027 Oslo, Norway. jens.ivar.brox@rikshospitalet.no

Abstract

OBJECTIVES:

To compare the long-term effectiveness of surgical and non-surgical treatment in patients with chronic low back pain.

METHODS:

Two merged randomised clinical trials compared instrumented transpedicular fusion with cognitive intervention and exercises in 124 patients with disc degeneration and at least 1 year of symptoms after or without previous surgery for disc herniation. The main outcome measure was the Oswestry disability index.

RESULTS:

At 4 years 14 (24%) patients randomly assigned to cognitive intervention and exercises had also undergone surgery. 15 (23%) patients assigned fusion had undergone re-surgery. The mean treatment effect for the primary outcome was 1.1; 95% CI -5.9 to 8.2, according to the intention-to-treat analysis and -1.6; 95% CI -8.9 to 5.6 in the as-treated analysis. There was no difference in return to work.

CONCLUSIONS:

Long-term improvement was not better after instrumented transpedicular fusion compared with cognitive intervention and exercises.

Comment in

PMID:
19635718
PMCID:
PMC2938881
DOI:
10.1136/ard.2009.108902
[Indexed for MEDLINE]
Free PMC Article
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