Houston Methodist. Leading Medicine

Lower Spine News

Fusion No Better than Activity or Exercise for Chronic Back Pain

What's the best treatment for patients who still have back pain a year or more after the disc is removed? In this study two treatment methods were compared. Patients in the first group had spinal fusion. Screws and bone graft were used to fuse one segment in the lumbar spine. All patients in the study had the disc removed (called a discectomy) for disc herniation.

The second group was given advice and exercises. Patients in this group received education and advice about their condition. They were told about the importance of movement and activity. They were advised that they could not hurt their back by doing every day activities. Three types of exercises were included: aerobic or outdoor activities, pool therapy, and individual exercises.

Results were measured by pain intensity, use of daily drugs for pain, and general function. Patients also rated their emotional distress and answered questions about work status. X-rays were taken of the patients who had a fusion to see if the fusion was successful. Everyone was followed for one year.

The authors report that more people in the study believed surgery was better than non-operative treatment. Even so the results showed no difference between the two groups. The success rate was about 50 percent in both groups. Two men in the exercise group had surgery later and still did not improve. There was major improvement in function in both groups.

The authors conclude spinal fusion surgery is being done for many low back pain patients. More studies are needed to identify which patients can benefit the most from this type of treatment. The results of this study suggest that fusion is not advised for patients with chronic low back pain after discectomy.

Jens Ivar Brox, et al. Lumbar Instrumented Fusion Compared with Cognitive Intervention and Exercises in Patients with Chronic Back Pain after Previous Surgery for Disc Herniation: A Prospective Randomized Controlled Study. In Pain. May 2006. Vol. 122. No. 1-2. Pp. 145-155.


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