Surgery, Exercise Long-Term Outcomes Equal for Back Pain
(HealthDay News) – Over nine years of follow-up, patients with chronic low back pain randomized to lumbar fusion do not report better outcomes than those receiving cognitive intervention and exercises, according to a study published in the December issue of the European Spine Journal.
Anne Froholdt, MD, from the Oslo University Hospital in Norway, and colleagues compared the nine-year outcomes in patients with chronic low back pain treated by either instrumented lumbar fusion or with cognitive intervention and exercises. The Oswestry Disability Index (ODI) was used as the main outcome measure.
The researchers found that one-third of the patients who were randomly allocated to cognitive intervention and exercises had crossed over and undergone surgery, while one-third of those allocated to lumbar fusion had undergone reoperation. There were no differences between the groups in intention-to-treat analysis. For ODI, the mean adjusted treatment effect was 1.9 (95% confidence interval, -7.8–11.6). More operated patients used pain medication and were out of work, based on analysis according to treatment received.
"Patients randomized to lumbar fusion did not report better long-term outcome compared to cognitive intervention and exercises," the authors write. "Both randomized groups reported less pain and better function at nine years compared to baseline (and one-year follow-up), but more operated patients used pain medication and were out of work. However, more patients [who were operated on] reported that they were better than before surgery."