No difference in 9-year outcome in CLBP patients randomized to lumbar fusion versus cognitive intervention and exercises.
OBJECTIVE
To compare the 9-year outcome in patients with chronic low back pain treated by instrumented lumbar fusion versus cognitive intervention and exercises.


METHODS
The main outcome measure was the Oswestry Disability Index (ODI). Secondary outcome measures included pain, fear-avoidance beliefs, trunk muscle strength, medication, and return to work.


RESULTS
One-third of the patients randomized to cognitive intervention and exercises had crossed over and been operated and one-third of the patients allocated to lumbar fusion had been re-operated. The intention-to-treat analysis detected no differences between the two groups. The mean adjusted treatment effect for ODI was 1.9 (95 % CI -7.8 to 11.6). Analysed according to the treatment received, more operated patients used pain medication and were out of work.


CONCLUSIONS
The outcome at 9 years was not different between instrumented lumbar fusion and cognitive intervention and exercises.
Department of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet 0027, Oslo, Norway. anne.froholdt@oslo-universitetssykehus.no
Anne
A
Froholdt
Olav
O
Reikeraas
Inger
I
Holm
Anne
A
Keller
Jens Ivar
JI
Brox
D000328:Adult; D059350:Chronic Pain / Q000534:rehabilitation / Q000601:surgery; D015928:Cognitive Behavioral Therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation* / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion; D016896:Treatment Outcome