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:hulonglz@163.com
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
