title: Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain.
abstract: OBJECTIVE
  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.
authors.affiliation: Orthopaedic Department, Oslo University Hospital-Rikshospitalet, Sognsvannsveien, 0027 Oslo, Norway. jens.ivar.brox@rikshospitalet.no
authors.forename: Jens Ivar
authors.initials: JI
authors.lastname: Brox
authors.forename: Øystein P
authors.initials: ØP
authors.lastname: Nygaard
authors.forename: Inger
authors.initials: I
authors.lastname: Holm
authors.forename: Anne
authors.initials: A
authors.lastname: Keller
authors.forename: Tor
authors.initials: T
authors.lastname: Ingebrigtsen
authors.forename: Olav
authors.initials: O
authors.lastname: Reikerås
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation / Q000601:surgery / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome