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Preoperative conservative treatment is insufficiently described in clinical trials of lumbar fusion: a scoping review

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Abstract

Purpose

To identify how pre-surgical conservative care is characterized and reported in randomized controlled trials of adults undergoing elective lumbar fusion, including duration and type of treatment.

Methods

The study design is a scoping review. Data sources include PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid Medline, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). All randomized controlled trials published in English between January 1, 2005, and February 15, 2022, assessing lumbar fusion as the intervention were included in this review.

Results

Of 166 studies, 62.0% reported a failure in conservative care prior to lumbar fusion, but only 15.1% detailed the type of specific conservative care received. None of the trials provided sufficient details to understand the nature of the pre-surgical conservative treatment, such as frequency, recency/timing, or dosage of conservative interventions.

Conclusion

Although roughly two-thirds of trials reported that patients failed conservative care prior to receiving a lumbar fusion, few studies named the conservative intervention provided and no studies provided any details regarding dosing or recency of care. This lack of information creates ambiguity in the surgical decision-making process, setting the assumption that all patients received adequate conservative care prior to surgery. Details about pre-surgical conservative care should be disclosed to allow for appropriate clinical application, decision-making, and interpretation of treatment effects.

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Data availability

Data is available upon request from the authors

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Authors and Affiliations

  1. Doctor of Science in Physical Therapy Program, Bellin College, Eaton Road, Green Bay, WI, 54311, USA

    Lauren M. Nielsen, Emily N. Getz, Jodi L. Young & Daniel I. Rhon

  2. Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Daniel I. Rhon

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PubMed search strategy Spinal fusion(MeSH terms) or arthrodesis(MeSH terms) or arthrodesis(title/abstract) or spinal fusion(title/abstract) or spinal fusions(title/abstract) or spine fusion(title/abstract) or spine fusions(title/abstract) or spondylodesis(title/abstract) or spondylosyndesis(title/abstract) or lumbar fusion(title/abstract) or lumbar fusions(title/abstract) or lumbar cage(title/abstract) or spine surgery(title/abstract) or spinal surgery(title/abstract) or spinal cage(title/abstract) or spine cage(title/abstract) or interbody cage(title/abstract) or interbody fusion(title/abstract) or interbody fusion(title/abstract) or spine arthrodesis(title/abstract) or spinal arthrodesis(title/abstract) or lumbar arthrodesis(title/abstract) or lumbar stabilization surgery(title/abstract).

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Nielsen, L.M., Getz, E.N., Young, J.L. et al. Preoperative conservative treatment is insufficiently described in clinical trials of lumbar fusion: a scoping review. Eur Spine J 33, 264–273 (2024). https://doi.org/10.1007/s00586-023-07926-8

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