Authors: Ibrahim, T.¹; Tleyjeh, I.²; Gabbar, O.³

Source: International Orthopaedics, Volume 32, Number 1, February 2008 , pp. 107-113(7)

Publisher: Springer

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, I² = 44.4%). Surgical treatment was associated with a 16% pooled rate of early complication (95%CI: 12-20, I² = 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.

Document Type: Research article

DOI: http://dx.doi.org/10.1007/s00264-006-0269-6

Affiliations: 1: Department of Orthopaedic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK, Email: ti11@le.ac.uk 2: Department of Medicine, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA 3: Department of Orthopaedic Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK

Publication date: 2008-02-01

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