Meta-analysis of randomized trials comparing fusion surgery to non-surgical treatment for discogenic chronic low back pain

Article type: Research Article

Authors: Wang, Xin^a | Wanyan, Pingping^b | Tian, Jin Hui^c | Hu, Long^{a; *}

Affiliations: [a] First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Lanzhou, Gansu, China | [b] The Second Hospital of Lanzhou University, Lanzhou, Gansu, China | [c] Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China

Correspondence: [*] Corresponding author: Long Hu, First Clinical Medical College of Lanzhou University, The First Hospital of Lanzhou University, Dong Gang West Road, No. 199, Lanzhou 730000, Gansu, China. E-mail:[email protected]

Abstract: BACKGROUND: Chronic low back pain causes socioeconomic burdens. Whether lumbar fusion is more effective than nonsurgical treatment of discogenic low back pain (DLBP) is controversial. Several randomized controlled trials that compared conservative treatment and fusion surgery had conflicting conclusions. OBJECTIVE: To compare between the effectiveness of lumbar fusion and nonsurgical intervention in patients with chronic low back pain caused by disc degeneration. METHODS: PubMed, the Cochrane Library, EMBASE, the Science Citation Index, Chinese Biomedical Literature Database, and references of relevant papers published from 1990 to 2013 were searched. Related data matching standards established for this research were extracted and statistically analyzed by using the RevMan (5.2) software. RESULTS: Meta-analysis of 6 randomized controlled trials with a total of 889 patients revealed no difference in Oswestry Disability Index (ODI) score for DLBP between the fusion surgery and nonsurgical groups (mean difference, 1.94; 95% confidence interval [CI], -6.02 to 2.14). Postsurgical complication rate significantly differed between the 2 groups (risk ratio, 22.11; 95% CI, 55.99-81.60). CONCLUSIONS: Fusion surgery was not superior to nonsurgical treatment in terms of changes in ODI scores for DLBP. Fusion surgery resulted in surgical complications. Longer follow-up observation is necessary regarding condition-specific disability, pain, and life satisfaction.

Keywords: Discogenic chronic back pain, lumbar fusion, nonsurgical treatment, meta-analysis

DOI: 10.3233/BMR-140571

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 621-627, 2015