STUDY DESIGN:
Systematic literature review.

OBJECTIVE:
To categorize published evidence systematically for lumbar fusion for chronic low back pain (LBP) in order to provide an updated and comprehensive analysis of the clinical outcomes.

SUMMARY OF BACKGROUND DATA:
Despite a large number of publications of outcomes of spinal fusion surgery for chronic LBP, there is little consensus on efficacy.

METHODS:
A MEDLINE and Cochrane database search was performed to identify published articles reporting on validated patient-reported clinical outcomes measures (2 or more of visual analogue scale, Oswestry Disability Index, Short Form [36] Health Survey [SF-36] PCS, and patient satisfaction) with minimum 12 months of follow-up after lumbar fusion surgery in adult patients with LBP due to degenerative disc disease. Twenty-six total articles were identified and stratified by level of evidence: 18 level 1 (6 studies of surgery vs. nonoperative treatment, 12 studies of alternative surgical procedures), 2 level 2, 2 level 3, and 4 level 4 (2 prospective, 2 retrospective). Weighted averages of each outcomes measure were computed and compared with established minimal clinically important difference values.

RESULTS:
Fusion cohorts included a total of 3060 patients. The weighted average improvement in visual analogue scale back pain was 36.8/100 (standard deviation [SD], 14.8); in Oswestry Disability Index 22.2 (SD, 14.1); in SF-36 Physical Component Scale 12.5 (SD, 4.3). Patient satisfaction averaged 71.1% (SD, 5.2%) across studies. Radiographical fusion rates averaged 89.1% (SD, 13.5%), and reoperation rates 12.5% (SD, 12.4%) overall, 9.2% (SD, 7.5%) at the index level. The results of the collective studies did not differ statistically in any of the outcome measures based on level of evidence (analysis of variance, P > 0.05).

CONCLUSION:
The body of literature supports fusion surgery as a viable treatment option for reducing pain and improving function in patients with chronic LBP refractory to nonsurgical care when a diagnosis of disc degeneration can be made.





Polls results
1

On a scale of 1 to 10, rate how much this article will change your clinical practice?

NO change
BIG change
100% Article relates to my practice (3/3)
0% Article does not relate to my practice (0/3)
0% Undecided (0/3)
2

Will this article lead to more cost-effective healthcare?

33% Yes (1/3)
66% No (2/3)
0% Undecided (0/3)
3

Was this article biased? (commercial or personal)

33% Yes (1/3)
66% No (2/3)
0% Undecided (0/3)
4

What level of evidence do you think this article is?

0% Level 1 (0/3)
0% Level 2 (0/3)
66% Level 3 (2/3)
33% Level 4 (1/3)
0% Level 5 (0/3)