Article

We assess the effect of lumbar fusion (LF) in reducing disability among patients
with chronic low back pain (CLBP) compared with conservative treatment and to
weigh the clinical significance of this effect. We conducted a random-effect
meta-analysis on the basis of a systematic review with research quality grading
according to Grading of Recommendations Assessment, Development and Evaluation
(GRADE). The studies included were retrieved from MEDLINE and Cochrane CENTRAL
databases from 1990 till January 2013. Randomized or nonrandomized controlled
studies were included if the study participants had a history of CLBP because of
degenerative spinal diseases and had been treated with LF. A study was included
if it compared LF with conservative treatment. The outcome measure was a change
in the Oswestry Disability Index (ODI) score during a follow-up. The
meta-analysis included data on 666 patients (402 cases) who participated in four
randomized-controlled trials. The ODI score reduced in the LF and the control
groups. The mean reduction in the ODI score in the follow-up of 1.5 years was
-2.91 (95% confidence interval -6.66 to 0.84) in favor of LF. The difference
between groups was statistically and clinically insignificant. Test for
heterogeneity indicated that study imputation would favor LF but the imputed
result would still be clinically insignificant with an estimated corrected
reduction of ODI score of -5.51 (95% confidence interval -5.78 to -5.24). There
is strong evidence that LF is not more effective than conservative treatment in
reducing perceived disability because of CLBP among patients with degenerative
spinal diseases. It is unlikely that further research on the subject would considerably affect this conclusion.

Langue : ANGLAIS