Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials.
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.
Ibrahim
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Department of Orthopaedic Surgery, Leicester General Hospital, Leicester, UK. ti11@le.ac.uk
Tleyjeh
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IM
Gabbar
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D002908:Chronic Disease; D006233:Persons with Disabilities / Q000145:classification; D006801:Humans; D017116:Low Back Pain / Q000191:economics / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D013123:Spinal Fusion; D016896:Treatment Outcome