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Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration

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dc.contributor.author Brox, Jens Ivar eng
dc.contributor.author Sørensen, Roger eng
dc.contributor.author Friis, Astrid eng
dc.contributor.author Nygård, Øystein eng
dc.contributor.author Indahl, Aage eng
dc.contributor.author Keller, Anne eng
dc.contributor.author Ingebrigtsen, Tor eng
dc.contributor.author Eriksen, Hege Randi eng
dc.contributor.author Holm, Inger eng
dc.contributor.author Koller, Anne Kathrine eng
dc.contributor.author Riise, Rolf eng
dc.contributor.author Reikerås, Olav eng
dc.date.accessioned 2006-11-01T14:51:57Z
dc.date.available 2006-11-01T14:51:57Z
dc.date.issued 2003 eng
dc.identifier.citation Spine 28(17): 1913-1921
dc.identifier.issn 0362-2436 eng
dc.identifier.uri http://hdl.handle.net/1956/1929
dc.description Reproduced with permission from the publisher en
dc.description.abstract <p>Study Design: Single blind randomized study.</p> <p>Objectives: To compare the effectiveness of lumbar instrumented fusion with cognitive intervention and exercises in patients with chronic low back pain and disc degeneration.</p> <p>Summary of Background Data: To the authors’ best knowledge, only one randomized study has evaluated the effectiveness of lumbar fusion. The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician. </p> <p>Patients and Methods: Sixty-four patients aged 25–60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4–L5 and/or L5–S1 at radiographic examination were randomized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy, or cognitive intervention and exercises. The cognitive intervention consisted of a lecture to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The main outcome measure was the Oswestry Disability Index.</p> <p>Results: At the 1-year follow-up visit, 97% of the patients, including 6 patients who had either not attended treatment or changed groups, were examined. The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery, compared with 42 to 30 after cognitive intervention and exercises. The mean difference between groups was 2.3 (-6.7 to 11.4) (P = 0.33). Improvements inback pain, use of analgesics, emotional distress, life satisfaction, and return to work were not different. Fearavoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment, and lower limbpain was reduced more after surgery. The success rateaccording to an independent observer was 70% after surgery and 76% after cognitive intervention and exercises. The early complication rate in the surgical group was 18%.</p> <p>Conclusion: 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.</p> en
dc.format.extent 485918 bytes eng
dc.format.mimetype application/pdf eng
dc.language.iso eng eng
dc.publisher Lippincott, Williams & Wilkins en
dc.rights Copyright Lippincott, Williams & Wilkins eng
dc.subject Chronic low back pain eng
dc.subject Disc degeneration eng
dc.subject Randomized eng
dc.subject Clinical trial eng
dc.subject Lumbar fusion eng
dc.subject Cognitive eng
dc.subject Exercises eng
dc.subject Fear-avoidance beliefs eng
dc.title Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration en
dc.type Journal article eng
dc.type.version publishedVersion eng
bora.peerreviewed Peer reviewed eng
bora.journalTitle Spine eng
bibo.volume 28 eng
bibo.issue 17 eng
bibo.pageStart 1913 eng
bibo.pageEnd 1921 eng
bibo.doi http://dx.doi.org/10.1097/01.BRS.0000083234.62751.7A eng
dc.identifier.doi http://dx.doi.org/10.1097/01.BRS.0000083234.62751.7A


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