Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of prospective comparative studies
PubMed 33253955 · doi:10.1016/j.wneu.2020.11.121
What was done
Meta-analysis of prospective studies searched across PubMed, Embase, Cochrane Library, and CNKI through June 30, 2020, comparing lumbar fusion against nonoperative care for chronic low back pain associated with degenerative disk disease. Primary outcomes were Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg pain scores, complications, and all-cause additional surgeries at short-term (<2 years) and long-term (≥2 years) follow-up.
What was found
Six prospective studies were included (159 patients with short-term follow-up; 675 with long-term follow-up). Lumbar fusion and nonoperative care showed little difference in short- and long-term ODI and VAS scores for back and leg pain (specific numerical scores not provided in the abstract). In long-term follow-up, lumbar fusion had a lower rate of additional surgeries (risk ratio 0.40; 95% CI, 0.17 to 0.98; P = 0.04) but a substantially higher complication rate (risk ratio 21.46; 95% CI, 4.34 to 106.04; P = 0.0002).
Why it matters
This review demonstrates that lumbar fusion offers no clinically meaningful pain or functional benefit over conservative management for discogenic back pain. Clinicians must weigh the lower rate of subsequent operations against a markedly higher complication risk associated with fusion surgery.
Limits
The total sample size across the six prospective studies is relatively small (n = 675 long-term). Quantitative point estimates and confidence intervals for pain and disability scores were omitted from the abstract. The authors also note lax patient inclusion criteria in the included trials.
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- context Spinal fusion surgery for chronic back pain does not work at least half of the time.