Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain

Ann Rheum Dis. 2010 Sep;69(9):1643-8. doi: 10.1136/ard.2009.108902. Epub 2009 Jul 26.


Objectives: To compare the long-term effectiveness of surgical and non-surgical treatment in patients with chronic low back pain.

Methods: Two merged randomised clinical trials compared instrumented transpedicular fusion with cognitive intervention and exercises in 124 patients with disc degeneration and at least 1 year of symptoms after or without previous surgery for disc herniation. The main outcome measure was the Oswestry disability index.

Results: At 4 years 14 (24%) patients randomly assigned to cognitive intervention and exercises had also undergone surgery. 15 (23%) patients assigned fusion had undergone re-surgery. The mean treatment effect for the primary outcome was 1.1; 95% CI -5.9 to 8.2, according to the intention-to-treat analysis and -1.6; 95% CI -8.9 to 5.6 in the as-treated analysis. There was no difference in return to work.

Conclusions: Long-term improvement was not better after instrumented transpedicular fusion compared with cognitive intervention and exercises.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Chronic Disease
  • Cognitive Behavioral Therapy
  • Combined Modality Therapy
  • Disability Evaluation
  • Exercise Therapy
  • Female
  • Follow-Up Studies
  • Health Services / statistics & numerical data
  • Humans
  • Low Back Pain / rehabilitation
  • Low Back Pain / surgery
  • Low Back Pain / therapy*
  • Lumbar Vertebrae / surgery
  • Male
  • Middle Aged
  • Reoperation
  • Spinal Fusion / adverse effects
  • Spinal Fusion / methods
  • Treatment Outcome