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Therapeutics
Lumbar fusion did not differ from cognitive therapy plus exercise for reducing disability and pain in chronic low back pain
Brox JI, Sørensen R, Friis A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 2003;28:1913–1921.[CrossRef][Medline]
Q In patients with chronic low back pain (CLBP), is instrumented lumbar fusion (ILF) more effective than cognitive therapy plus exercise (CTE) for reducing CLBP related disability and pain?
Neurology
Key Words: low back pain • disc degeneration • spinal fusion • cognitive therapy
| The first 150 words of the full text of this article appear below. |
Design:
randomised controlled trial.
Allocation:
concealed.*
Blinding:
outcome assessors.*
Follow up period:
1 year.
Setting:
4 hospitals in Norway.
Patients:
64 patients 25–60 years of age (mean age 43 y, 61% men) with CLBP that lasted >1 year who had Oswestry Disability Index (ODI) 
30 of 100 points, and degeneration at L4–L5 and/or L5–S1 (spondylosis) on plain radiographs. Exclusion criteria included widespread myofascial pain, spinal stenosis with reduced walking distance and neurological signs, and recurrent disc herniation or lateral recess stenosis with clinical signs of radiculopathy.
Intervention:
patients were allocated to ILF (n = 37) or CTE (n = 27). ILF consisted of posterolateral fusion with transpedicular screws of the L4–L5 segment and/or L5–S1 segment plus physiotherapy. Patients in the CTE group received a lecture explaining that ordinary physical activity would not harm the disc, and a recommendation to bend the back and use it. This recommendation was reinforced by
University of Pennsylvania
Philadelphia, Pennsylvania, USA
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