Spinal fusion

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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

  1. Anonymous (2015), Spinal fusion (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 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.
  3. 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
  4. 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.
  5. 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]
  6. 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.
  7. 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.
  8. 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