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Randomized Controlled Trial
. 2008 Oct 1;33(21):2334-40.
doi: 10.1097/BRS.0b013e318186a8b2.

The MRC Spine Stabilization Trial: Surgical Methods, Outcomes, Costs, and Complications of Surgical Stabilization

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Randomized Controlled Trial

The MRC Spine Stabilization Trial: Surgical Methods, Outcomes, Costs, and Complications of Surgical Stabilization

James Wilson-MacDonald et al. Spine (Phila Pa 1976). .

Abstract

Study design: A review of the surgical costs and results in a group of patients randomly allocated to surgery as part of a large prospective randomized trial of patients with chronic back pain.

Objective: To report the observational data from the surgical arm of a randomized trial comparing surgery with intensive rehabilitation for chronic low back pain. Clinical and economic data are reported.

Summary of background data: Surgery for chronic low back pain is a well established but unproven intervention. The most cost-effective technique for spinal stabilization is still not established.

Methods: One hundred six patients with chronic low back pain were randomized to the surgical group of a randomized trial comparing spinal fusion of the lumbar with a 3 week intensive rehabilitation program. The primary outcomes were the Oswestry Disability Index (ODI) and the Shuttle Walking Test measured at baseline and 2 years postrandomization. Patients were stratified by preoperative diagnosis, smoking habit, and litigation. Complications were assessed and costs analyzed.

Results: Of the 176 surgical patients, 56 underwent postero-lateral fusion, 57 underwent interbody fusion, and 24 underwent flexible stabilization of the spine. The mean ODI for all patients in the surgical arm of the trial improved from a baseline of 46.5 (SD 14.6) to 34.2 (SD 21) at 2 years. Health care costs were higher ( 3109 pounds difference) for more complex procedures, and nearly 6 times as many early complications occurred with the more complex procedures. Smoking and unemployment were associated with worse results whereas litigation did not adversely affect the outcome.

Conclusion: These observational changes in the ODI after surgery are similar to those reported from other studies of spinal fusion. More complex surgery is more expensive with more complications than postero-lateral fusion.

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