Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials

Abstract

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.

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Surgical Management of Low Back Pain and Degenerative Spinal Disorders

“…Because the diagnosis of DDD is still controversial, these studies are still non-specific in terms of diagnostic categorization. In a meta-analysis of randomized trials comparing fusion to conservative treatment for DDD, surgery led to improved functional scores compared to non-surgical treatment (Ibrahim et al, 2008). However, the difference in functional improvement was not statistically significant.…”

The management of acute low back pain in adults: a guide for the primary care physician, Part II

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