Questioning Lumbar Fusion for Disc DegenerationFusion surgery is one of the possible fixes for low back pain caused by disc
degeneration. Fusion surgery involves using bone grafts and screws to separate and hold two or more vertebrae. The goal is to hold the fused section perfectly still to stop the pain.
This study from Norway casts doubt on whether fusion in the low back is necessary to treat disc degeneration. These authors compared two groups of patients with back pain from disc degeneration. All had low back pain for longer than one year. One group got fusion surgery using screws. They then attended a standard rehabilitation program.
The other group had no surgery. Instead, they took part in an intensive rehab program over six weeks. These patients spent about 25 hours each week on the program. The program included education and exercise classes. Patients also went to group classes. They did three workouts a day. They got individual training and help. And they were always encouraged to use their backs and to do their regular activities.
After one year, both groups showed about the same amount of improvement. There were only a few real differences. Patients in the surgery group were more afraid of doing certain activities. They also had a harder time bending over and touching the floor. The exercise group had somewhat more leg pain.
The authors were surprised by these results. They had expected the surgery group to do much better than the exercise group. Exercise and education can be much less expensive than surgery. The authors note that combining surgery with the education and exercise program could have even better results. The authors suggest that research on bigger groups of patients is needed to truly understand the best way to use lumbar fusion when treating disc degeneration.
Jens Ivar Brox, MD, PhD, et al. Randomized Clinical Trial of Lumbar Instrumented Fusion and Cognitive Intervention and Exercises in Patients with Chronic Low Back Pain and Disc Degeneration. In Spine. September 1, 2003. Vol. 28. No. 17. Pp. 1913-1921.
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