Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain.
Ann Rheum Dis*. 2010;69:1643-1648.
Surgery is not superior to a short, intensive cognitive and exercise intervention among patients with common low back pain. This research suggests that surgical treatment for chronic low back pain may be overused. Nearly 80% of patients continue to experience some pain or disability at 1 year following their initial clinic visit for low back pain. In a more recent study of 973 primary care patients with less than 2 weeks of low back pain, the rates of returning to work were approximately 50% at 14 days and 83% at 3 months. The fact that many patients have lingering symptoms, in combination with the introduction and promotion of new surgical techniques and equipment, has led to an explosive increase in the use of surgery for low back pain.
Surgery did not improve pain or disability compared with usual care on intent-to-treat analysis. Prescribed exercises with chronic low back pain found that outcomes were similar in the surgical and nonsurgical groups.
Clinical Pearls – More than one fourth of Americans have experienced significant back pain in the past 3 months, and the total cost of low back pain exceeds $100 billion per year in the United States alone; – Surgical treatment of low back pain has become more prevalent; – In the current study, an intensive, brief program of cognitive and exercise treatment produced similar outcomes as surgical treatment of chronic low back pain; – The current study is in accord with previous systematic reviews of treatment for low back pain without significant anatomic changes (such as spinal stenosis) or symptoms (such as radiculopathy); and – Further research could highlight how to use elements of the intensive back rehabilitation program in everyday practice.