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Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain.
  1. Jens Ivar Brox (jens.ivar.brox{at}
  1. Rikshospitalet University Hospital, Norway
    1. Øystein Nygaard (oystein.nygaard{at}
    1. St.Olavs Hospital, Norway
      1. Inger Holm (inger.holm{at}
      1. Rikshospitalet University Hospital, Norway
        1. Anne Keller (anne.keller{at}
        1. Ulleval University Hospital, Norway
          1. Tor Ingebrigtsen (tor.ingebrigtsen{at}
          1. University North Norway, Norway
            1. Olav Reikerås (olav.reikeras{at}
            1. Rikshospitalet University Hospital, Norway


              Objectives: To compare long-term effectiveness of surgical with non surgical treatment in patients with chronic low back pain.

              Methods: Two merged randomised clinical trials compared instrumented transpedicular fusion with cognitive intervention and exercises in 124 patients with disc degeneration and at least 1 year of symptoms after or without previous surgery for disc herniation. The main outcome measure was the Oswestry Disability Index.

              Results: At 4 years 14 (24%) patients randomly assigned to cognitive intervention and exercises had also undergone surgery. Fifteen (23%) patients assigned fusion had undergone re-surgery. The mean treatment effect for the primary outcome was 1.1; 95% CI: -5.9 to 8.2, according to the intention-to-treat analysis, and -1.6; 95% CI: -8.9 to 5.6 in the as-treated analysis. There was no difference in return to work.

              Conclusions: Long-term improvement was not better after instrumented transpedicular fusion compared with cognitive intervention and exercises.

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