Study investigates lumbar fusion vs physical therapy for treatment of low back pain
Results from this study indicated lumbar fusion as a treatment option for chronic low back pain with regard to the global assessment and patient perspective; however, secondary outcomes comparing fusion with conservative management showed disability remained at long-term follow-up after both treatment methods.
Researchers identified 294 patients who had chronic low back pain for at least 2 years. Patients were randomized to undergo either lumbar fusion or non-specific physiotherapy. There was a mean follow-up of 12.8 years. The primary outcome was the global assessment (GA) of back pain. Secondary outcomes included the Oswestry Disability Index (ODI), VAS for back and leg pain, and Zung depression scale. Investigators also recorded work status, pain medications and pain frequency.
Investigators obtained patients’ questionnaires prior to treatment and at long-term follow-up. The following four different models were used for data analysis: an intention-to-treat model; “as treated” model; per protocol; and whether patients in the conservative treatment group changers were automatically grouped as unchanged or had a poor GA (GCAC). Multiple linear regression analysis was used to determine the differences between the treatment groups.
Results showed patients treated with fusion had a significantly better GA, with the exception of the intention-to-treat model. Investigators noted for the “as treated,” per protocol and GCAC models, the proportion of much better or better patients were greater for patients who underwent fusion. However, conservative and fusion groups had similar outcomes for ODI, VAS back pain, work status, pain medication and pain frequency, according to researchers. ‒ by Monica Jaramillo
Disclosures: Hedlund reports he receives grants from Acromed Corporation and Zimmer; and is a consultant for Globus Medical, Medtronic and Zimmer. Please see the full study for a list of all other authors’ relevant financial disclosures.