Document Detail

Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review.
MedLine Citation:
PMID:  23334400     Owner:  NLM     Status:  MEDLINE    
STUDY DESIGN: Systematic literature review.
OBJECTIVE: To categorize published evidence systematically for lumbar fusion for chronic low back pain (LBP) in order to provide an updated and comprehensive analysis of the clinical outcomes.
SUMMARY OF BACKGROUND DATA: Despite a large number of publications of outcomes of spinal fusion surgery for chronic LBP, there is little consensus on efficacy.
METHODS: A MEDLINE and Cochrane database search was performed to identify published articles reporting on validated patient-reported clinical outcomes measures (2 or more of visual analogue scale, Oswestry Disability Index, Short Form [36] Health Survey [SF-36] PCS, and patient satisfaction) with minimum 12 months of follow-up after lumbar fusion surgery in adult patients with LBP due to degenerative disc disease. Twenty-six total articles were identified and stratified by level of evidence: 18 level 1 (6 studies of surgery vs. nonoperative treatment, 12 studies of alternative surgical procedures), 2 level 2, 2 level 3, and 4 level 4 (2 prospective, 2 retrospective). Weighted averages of each outcomes measure were computed and compared with established minimal clinically important difference values.
RESULTS: Fusion cohorts included a total of 3060 patients. The weighted average improvement in visual analogue scale back pain was 36.8/100 (standard deviation [SD], 14.8); in Oswestry Disability Index 22.2 (SD, 14.1); in SF-36 Physical Component Scale 12.5 (SD, 4.3). Patient satisfaction averaged 71.1% (SD, 5.2%) across studies. Radiographical fusion rates averaged 89.1% (SD, 13.5%), and reoperation rates 12.5% (SD, 12.4%) overall, 9.2% (SD, 7.5%) at the index level. The results of the collective studies did not differ statistically in any of the outcome measures based on level of evidence (analysis of variance, P > 0.05).
CONCLUSION: The body of literature supports fusion surgery as a viable treatment option for reducing pain and improving function in patients with chronic LBP refractory to nonsurgical care when a diagnosis of disc degeneration can be made.
Frank M Phillips; Paul J Slosar; Jim A Youssef; Gunnar Andersson; Frank Papatheofanis
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Spine     Volume:  38     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-29     Completed Date:  2013-10-22     Revised Date:  2014-05-22    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E409-22     Citation Subset:  IM    
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MeSH Terms
Chronic Pain / etiology,  surgery*
Clinical Trials as Topic / statistics & numerical data
Cohort Studies
Disability Evaluation
Evidence-Based Medicine
Follow-Up Studies
Intervertebral Disc Displacement / complications,  surgery*
Low Back Pain / etiology,  surgery*
Lumbar Vertebrae / surgery*
Middle Aged
Pain Measurement
Patient Satisfaction
Randomized Controlled Trials as Topic / statistics & numerical data
Severity of Illness Index
Spinal Fusion* / psychology,  statistics & numerical data
Treatment Outcome
Comment In:
Spine (Phila Pa 1976). 2013 Oct 1;38(21):1901   [PMID:  23846504 ]
Spine (Phila Pa 1976). 2013 Oct 1;38(21):1902-3   [PMID:  23846503 ]
Spine (Phila Pa 1976). 2014 Apr 20;39(9):780-1   [PMID:  24525984 ]
Spine (Phila Pa 1976). 2014 Apr 20;39(9):782   [PMID:  24739586 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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