Spinal Fusion Surgery is No Better Than Rehab + CBT!!
Reference:Fairbank J, et al Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ. 2005 May 28;330(7502):1233. Epub 2005 May 23
This was a fairly large RCT in the UK that compared the clinical effectiveness of surgical spinal fusion with intensive rehabilitation based on principles of cognitive behaviour therapy (CBT) for patients presenting with chronic low back pain (LBP).
The authors’ conclusion after 2 years: There is “no clear evidence emerged that primary spinal fusion surgery was any more beneficial than intensive rehabilitation.”
Clinical Relevance: Considering the little difference between the two groups in terms of various functional outcome measures, the potential risk and extra cost of surgery should make surgeons and patients choose intensive rehab plus CBT BEFORE thinking about surgery.
Personal Comment:The “aggressive” rehab in this study consisted of progressive stabilization exercises 5 times /week for a 3 week period.
Posted on: October 10, 2006
Categories: Lumbar Spine