Lumbar fusion shows long-term benefits

Lumbar fusion is becoming an increasingly common treatment for low-back pain, but its long-term effects are relatively unknown. A doctoral thesis from the Swedish medical university Karolinska Institutet now shows that the long-term effects are superior to those of physiotherapy.

Chronic low-back pain is treated increasingly often with lumbar fusion, by which several lower back vertebrae are fused in a way that has little impact on the back's overall mobility. Lumbar fusion has been shown to relieve pain in the short term, but no studies have examined the long-term effects of the operation and compared them with alternative, non-surgical treatments like physiotherapy.

Per Ekman is a surgeon at Stockholm South General Hospital (Sodersjukhuset), and has shown in his doctoral thesis that patients who have undergone lumbar fusion also improve in the longer term. His results are based on an evaluation of 111 patients, randomly assigned treatment with lumbar fusion or physiotherapy. On a follow-up nine years later, 76 per cent of the surgical group stated that they felt better than before the operation, compared with only 50 per cent of the physiotherapy group.

"Whether lumbar fusion should be used at all for this type of back pain has long been the subject of much debate," says Dr Ekman. "My studies suggest that most patients who have undergone lumbar fusion actually feel better, and that the operation carries no great risk. However, long-term improvements are often relatively modest, and the operation should also continue to be used as a complement to physiotherapy when this treatment doesn't help."

His thesis shows that men, the physically active and the gainfully employed have somewhat higher chances of benefitting from the operation than others.

"This tells us something, but unfortunately there are still no good methods for finding those with the best chances of responding well to the operation," says Dr Ekman.

Thesis: Lumbar fusion for chronic low-back pain in isthmic spondylolisthesis, Per Ekman, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet.