TY - JOUR
T1 - Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation
T2 - A prospective randomized controlled study
AU - Brox, Jens Ivar
AU - Reikerås, Olav
AU - Nygaard, Øystein
AU - Sørensen, Roger
AU - Indahl, Aage
AU - Holm, Inger
AU - Keller, Anne
AU - Ingebrigtsen, Tor
AU - Grundnes, Oliver
AU - Lange, Johan Emil
AU - Friis, Astrid
PY - 2006/5
Y1 - 2006/5
N2 - The effectiveness of lumbar fusion for chronic low back pain after surgery for disc herniation has not been evaluated in a randomized controlled trial. The aim of the present study was to compare the effectiveness of lumbar fusion with posterior transpedicular screws and cognitive intervention and exercises. Sixty patients aged 25-60 years with low back pain lasting longer than 1 year after previous surgery for disc herniation were randomly allocated to the two treatment groups. Experienced back surgeons performed transpedicular fusion. Cognitive intervention consisted of a lecture intended to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The primary outcome measure was the Oswestry Disability Index (ODI). Outcome data were analyzed on an intention-to-treat basis. Ninety-seven percent of the patients, including seven of eight patients who had either not attended treatment (n = 5) or changed groups (n = 2), completed 1-year follow-up. ODI was significantly improved from 47 to 38 after fusion and from 45 to 32 after cognitive intervention and exercises. The mean difference between treatments after adjustment for gender was -7.3 (95% CI -17.3 to 2.7, p = 0.15). The success rate was 50% in the fusion group and 48% in the cognitive intervention/exercise group. For patients with chronic low back pain after previous surgery for disc herniation, lumbar fusion failed to show any benefit over cognitive intervention and exercises.
AB - The effectiveness of lumbar fusion for chronic low back pain after surgery for disc herniation has not been evaluated in a randomized controlled trial. The aim of the present study was to compare the effectiveness of lumbar fusion with posterior transpedicular screws and cognitive intervention and exercises. Sixty patients aged 25-60 years with low back pain lasting longer than 1 year after previous surgery for disc herniation were randomly allocated to the two treatment groups. Experienced back surgeons performed transpedicular fusion. Cognitive intervention consisted of a lecture intended to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The primary outcome measure was the Oswestry Disability Index (ODI). Outcome data were analyzed on an intention-to-treat basis. Ninety-seven percent of the patients, including seven of eight patients who had either not attended treatment (n = 5) or changed groups (n = 2), completed 1-year follow-up. ODI was significantly improved from 47 to 38 after fusion and from 45 to 32 after cognitive intervention and exercises. The mean difference between treatments after adjustment for gender was -7.3 (95% CI -17.3 to 2.7, p = 0.15). The success rate was 50% in the fusion group and 48% in the cognitive intervention/exercise group. For patients with chronic low back pain after previous surgery for disc herniation, lumbar fusion failed to show any benefit over cognitive intervention and exercises.
KW - Chronic low back pain
KW - Cognitive intervention
KW - Exercises
KW - Posterior lumbar instrumented fusion
KW - Previous discectomy
KW - Randomized clinical trial
UR - http://www.scopus.com/inward/record.url?scp=33646047393&partnerID=8YFLogxK
U2 - 10.1016/j.pain.2006.01.027
DO - 10.1016/j.pain.2006.01.027
M3 - Article
C2 - 16545523
AN - SCOPUS:33646047393
SN - 0304-3959
VL - 122
SP - 145
EP - 155
JO - Pain
JF - Pain
IS - 1-2
ER -