Living with chronic low back pain? A British study says surgery and intensive rehabilitation may be equally good options.

"Patients with low back pain who are considered by surgeons to be candidates for spinal fusion may obtain similar benefits from an intensive rehabilitation program as they do from surgery," says the study.

The study showed that surgery had a slight edge in easing low back pain but not enough to offset surgery's cost and potential risks. The results are posted on BMJ Online First.

Surgery, Rehab Compared

The study included 349 adults with chronic low back pain at 15 U.K. hospitals. Spinal fusion surgery was assigned to 176 patients.

The other participants (173 people) were assigned to get about 75 hours of intensive rehabilitation for flexibility, strength, endurance, and cognitive behavioral approaches to pain. They also got follow-up sessions one, three, six, or 12 months later.

Participants were followed for two years; most completed the study. The results were based on questionnaires and tests of walking, which is often hampered by chronic low back pain.

Back Pain Results

The study's conclusion: "No clear evidence emerged that primary spinal fusion surgery was any more beneficial than intensive rehabilitation."

The surgery group's surveys showed a slightly bigger improvement in disability, but the difference was "marginal," write the researchers, who included Jeremy Fairbank, MD, FRCS, a consultant orthopaedic surgeon at Nuffield Orthopaedic Centre in Oxford, England.

During the study, "both groups improved over time," and some of that improvement may have been "a natural resolution of back pain," say Fairbank and colleagues.

Data's Details

Some people in each group did not get their assigned treatment (21 percent of the surgery group and 13 percent of the rehabilitation group).

In addition, 97 people in the surgery group and 68 in the rehabilitation group needed further treatment later on, says the study. Also, the study's measurements may have been too blunt to assess the complexities of back pain, say the researchers.

Still, the findings should help doctors and service providers make decisions about managing chronic low back pain, say Fairbank and colleagues.

A separate cost-effectiveness analysis (by many of the same researchers) showed that the results could change if more people who got rehab eventually need back surgery. Further follow-up should be done, say the researchers.


By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Fairbank, J. BMJ Online First, May 23, 2005. Rivero-Arias, O. BMJ Online First, May 23, 2005. News release, BMJ.