Original Article

European Spine Journal

, Volume 21, Issue 12, pp 2531-2538

No difference in 9-year outcome in CLBP patients randomized to lumbar fusion versus cognitive intervention and exercises

  • Anne FroholdtAffiliated withDepartment of Orthopaedic Surgery, Oslo University Hospital Email author 
  • , Olav ReikeraasAffiliated withDepartment of Orthopaedic Surgery, Oslo University Hospital
  • , Inger HolmAffiliated withDepartment of Physiotherapy, Oslo University Hospital
  • , Anne KellerAffiliated withDepartment of Physical Medicine and Rehabilitation, Oslo University Hospital
  • , Jens Ivar BroxAffiliated withDepartment of Orthopaedic Surgery, Oslo University Hospital

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Abstract

Purpose

To compare the 9-year outcome in patients with chronic low back pain treated by instrumented lumbar fusion versus cognitive intervention and exercises.

Methods

The main outcome measure was the Oswestry Disability Index (ODI). Secondary outcome measures included pain, fear-avoidance beliefs, trunk muscle strength, medication, and return to work.

Results

One-third of the patients randomized to cognitive intervention and exercises had crossed over and been operated and one-third of the patients allocated to lumbar fusion had been re-operated. The intention-to-treat analysis detected no differences between the two groups. The mean adjusted treatment effect for ODI was 1.9 (95 % CI −7.8 to 11.6). Analysed according to the treatment received, more operated patients used pain medication and were out of work.

Conclusions

The outcome at 9 years was not different between instrumented lumbar fusion and cognitive intervention and exercises.

Keywords

Randomized clinical trial Low back pain Long-term outcome Operative Physical therapy