Fusion vs Non-surgical Treatment for Discogenic CLBP

[NOSfan]

No surprise here! 😀

J Back Musculoskelet Rehabil. 2014 Dec 2.

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

Wang X1, Wanyan P2, Tian JH3, Hu L1.

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.

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[101N]

No surprise here! 😀

J Back Musculoskelet Rehabil. 2014 Dec 2.

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

Wang X1, Wanyan P2, Tian JH3, Hu L1.

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.

Thanks🙂

RCT's

1. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Brox JI, Sørensen R, Friis A, Nygaard Ø, Indahl A, Keller A, Ingebrigtsen T, Eriksen HR, Holm I, Koller AK, Riise R, Reikerås O. Spine (Phila Pa 1976). 2003 Sep 1;28(17):1913-21.

2. Surgical stabilisation of the spine compared with a programme of intensive rehabilitation for the management of patients with chronic low back pain: cost utility analysis based on a randomised controlled trial. Rivero-Arias O, Campbell H, Gray A, Fairbank J, Frost H, Wilson-MacDonald J. BMJ. 2005 May 28;330(7502):1239. Epub 2005 May 23.

3. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R; Spine Stabilisation Trial Group. BMJ. 2005 May 28;330(7502):1233. Epub 2005 May 23. Erratum in: BMJ. 2005 Jun 25;330(7506):1485.

META-ANALYSES

1. Spine J. 2013 Nov;13(11):1438-48. doi: 10.1016/j.spinee.2013.06.101. Epub 2013 Nov 5.
Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials.Mannion AF1, Brox JI, Fairbank JC.

2. Lumbar fusion versus nonoperative management for treatment of discogenic low back pain: a systematic review and meta-analysis of randomized controlled trials.
Bydon M, De la Garza-Ramos R, Macki M, Baker A, Gokaslan AK, Bydon A.
J Spinal Disord Tech. 2014

3. Meta-analysis of randomized trials comparing fusion surgery to non-surgical treatment for discogenic chronic low back pain. Wang X, Wanyan P, Tian JH, Hu L. J Back Musculoskelet Rehabil. 2014 Dec 2.

 

[emd123]

Where's the FDA panel and convention on banning fusions?

Where's the massive reimbursement cuts to the fusion cpt codes?

:crickets:

 

[jsaul]

Where's the FDA panel and convention on banning fusions?

Where's the massive reimbursement cuts to the fusion cpt codes?

:crickets:

because of the fusion industrial complex (i.e. the implant companies and orthopedic lobbies)

 

[Ligament]

I think what we need then are some patented injectables for our injections and let the pharma lobbies then fight for our procedures to protect their meds.

 

[SSdoc33]

I think what we need then are some patented injectables for our injections and let the pharma lobbies then fight for our procedures to protect their meds.

if someone can came up with an patented intradiscal injectable for discogenic LBP, this is exactly what would happen

 

[bedrock]

if someone can came up with an patented intradiscal injectable for discogenic LBP, this is exactly what would happen

Hard to patent stem cells, but a few companies are trying. This could spare some patients from lumbar fusions.