Spinal fusion
In medicine, spinal fusion is "operative immobilization or ankylosis of two or more vertebrae by fusion of the vertebral bodies with a short bone graft or often with diskectomy or laminectomy."[1]
Effectiveness
Degenerative spondylolisthesis and spinal stenosis
"In nonrandomized as-treated comparisons with careful control for potentially confounding baseline factors, patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically" according to a randomized controlled trial. [2]
Chronic nonspecific lumbalgia
Several systematic reviews of spinal fusion for chronic nonspecific lumbalgia have been performed."Surgery for radiculopathy with herniated lumbar disc and symptomatic spinal stenosis is associated with short-term benefits compared to nonsurgical therapy, though benefits diminish with long-term follow-up in some trials" according to one systematic review. [3]"Surgery may be more efficacious than unstructured nonsurgical care for chronic back pain but may not be more efficacious than structured cognitive-behavior therapy" according to one systematic review.[4]
Several randomized controlled trials of spinal fusion for chronic nonspecific lumbalgia have been performed."Lumbar fusion in a well-informed and selected group of patients with severe CLBP can diminish pain and decrease disability more efficiently than commonly used nonsurgical treatment." according to a randomized controlled trial. [5]" The success rate was 50% in the fusion group and 48% in the cognitive intervention/exercise group" according to a randomized controlled trial. [6]"The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration randomized to cognitive intervention and exercises, or lumbar fusion." according to a randomized controlled trial. [7]"Both groups reported reductions in disability during two years of follow-up, possibly unrelated to the interventions" according to a randomized controlled trial. [8]
References
- ↑ Anonymous (2023), Spinal fusion (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA et al. (2007). "Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis.". N Engl J Med 356 (22): 2257-70. DOI:10.1056/NEJMoa070302. PMID 17538085. PMC PMC2553804. Research Blogging.
- ↑ Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD (2009). "Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline.". Spine (Phila Pa 1976) 34 (10): 1094-109. DOI:10.1097/BRS.0b013e3181a105fc. PMID 19363455. Research Blogging. Review in: Ann Intern Med. 2009 Oct 20;151(8):JC4-11 Review in: Evid Based Med. 2009 Dec;14(6):180-1
- ↑ Mirza SK, Deyo RA (2007). "Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain.". Spine (Phila Pa 1976) 32 (7): 816-23. DOI:10.1097/01.brs.0000259225.37454.38. PMID 17414918. Research Blogging.
- ↑ Fritzell P, Hägg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Study Group (2001). "2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group.". Spine (Phila Pa 1976) 26 (23): 2521-32; discussion 2532-4. PMID 11725230. [e]
- ↑ Brox JI, Reikerås O, Nygaard Ø, Sørensen R, Indahl A, Holm I et al. (2006). "Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study.". Pain 122 (1-2): 145-55. DOI:10.1016/j.pain.2006.01.027. PMID 16545523. Research Blogging.
- ↑ Brox JI, Sørensen R, Friis A, Nygaard Ø, Indahl A, Keller A et al. (2003). "Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration.". Spine (Phila Pa 1976) 28 (17): 1913-21. DOI:10.1097/01.BRS.0000083234.62751.7A. PMID 12973134. Research Blogging.
- ↑ Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R et al. (2005). "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.". BMJ 330 (7502): 1233. DOI:10.1136/bmj.38441.620417.8F. PMID 15911537. PMC PMC558090. Research Blogging. Review in: J Fam Pract. 2005 Sep;54(9):752