Introduction This is a Prospective Comparative cohort study to determine the change in the Low Back Outcomes Score (LBOS) after intensive non-operative, multi-disciplinary treatment for low back pain and to compare this with data collected from earlier cohorts undergoing surgical fusion. Recently published Randomised Controlled Trials have been inconclusive regarding the benefits of surgery compared with rehabilitation for low back pain. We examine this question using the Low Back Outcome Score (LBOS) as an outcome measure.

Methods The LBOS was acquired prior to and two years following treatment in cohorts undergoing fusion or rehabilitation for low back pain. Follow up was 70% and 90% respectively. The surgical group had a lower starting LBOS ( 18 v 27) but the rehabilitation group had a higher proportion of cases involved in compensation, litigation, and who were not working.

Results A significantly greater improvement in LBOS was seen in the surgically treated group than was seen in the rehabilitation group (18 v 10)

Discussion Although we do not propose surgery before non-operative treatments are exhausted, these results suggest that surgical treatment can have significant benefits for selected patients who have not improved despite a state of the art rehabilitation programme.