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dc.contributor.authorBrox, Jens Ivareng
dc.contributor.authorSørensen, Rogereng
dc.contributor.authorFriis, Astrideng
dc.contributor.authorNygård, Øysteineng
dc.contributor.authorIndahl, Aageeng
dc.contributor.authorKeller, Anneeng
dc.contributor.authorIngebrigtsen, Toreng
dc.contributor.authorEriksen, Hege Randieng
dc.contributor.authorHolm, Ingereng
dc.contributor.authorKoller, Anne Kathrineeng
dc.contributor.authorRiise, Rolfeng
dc.contributor.authorReikerås, Olaveng
dc.date.accessioned2006-11-01T14:51:57Z
dc.date.available2006-11-01T14:51:57Z
dc.date.issued2003eng
dc.identifier.citationSpine 28(17): 1913-1921
dc.identifier.issn0362-2436eng
dc.identifier.urihttp://hdl.handle.net/1956/1929
dc.descriptionReproduced with permission from the publisheren
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.extent485918 byteseng
dc.format.mimetypeapplication/pdfeng
dc.language.isoengeng
dc.publisherLippincott, Williams & Wilkinseng
dc.subjectChronic low back paineng
dc.subjectDisc degenerationeng
dc.subjectRandomizedeng
dc.subjectClinical trialeng
dc.subjectLumbar fusioneng
dc.subjectCognitiveeng
dc.subjectExerciseseng
dc.subjectFear-avoidance beliefseng
dc.titleRandomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degenerationeng
dc.typeJournal articleeng
dc.rights.holderCopyright Lippincott, Williams & Wilkins
dc.type.versionpublishedVersioneng
bora.peerreviewedPeer reviewedeng
bora.journalTitleSpineeng
bibo.volume28eng
bibo.issue17eng
bibo.pageStart1913eng
bibo.pageEnd1921eng
bibo.doihttp://dx.doi.org/10.1097/01.BRS.0000083234.62751.7Aeng
dc.identifier.doihttp://dx.doi.org/10.1097/01.BRS.0000083234.62751.7A


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