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General Orthopaedics

SURGICAL VERSUS NON-SURGICAL TREATMENT OF CHRONIC LOW BACK PAIN: A META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS

British Orthopaedic Association (BOA) 2006



Abstract

To investigate the effectiveness of surgical fusion for chronic low back pain (CLBP) compared to non-surgical intervention, databases were searched from 1966-2005. The meta-analysis was based on the mean difference in Oswestry Disability Index (ODI) change from baseline to follow-up. Four studies were eligible (634 patients). The pooled mean difference in ODI was 4.13 in favour of surgery (95% CI: -0.82-9.08; p=0.10; I2=44.4%). Surgery was associated with a 16% pooled rate of complication (95% CI: 12-20%, I2=0%).

The cumulative evidence does not support surgical fusion for CLBP due to the marginal improvement in ODI which is of minimal clinical importance.