Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: A prospective randomized controlled study

Brox, Jens Ivar; Reikerås, Olav; Nygaard, ystein; Srensen, Roger; Indahl, Aage; Holm, Inger; Keller, Anne; Ingebrigtsen, Tor; Grundnes, Oliver; Lange, Johan Emil; Friis, Astrid

doi:10.1016/j.pain.2006.01.027

Cited by 296Spine and Intervertebral Disc PathologyMusculoskeletal pain and rehabilitationCervical and Thoracic Myelopathy

Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: A prospective randomized controlled study

Brox, Jens Ivar, Reikerås, Olav, Nygaard, ystein, Srensen, Roger, Indahl, Aage, Holm, Inger, Keller, Anne, Ingebrigtsen, Tor +3 more·2006·Pain

DOI 10.1016/j.pain.2006.01.027

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Abstract

The effectiveness of lumbar fusion for chronic low back pain after surgery for disc herniation has not been evaluated in a randomized controlled trial. The aim of the present study was to compare the effectiveness of lumbar fusion with posterior transpedicular screws and cognitive intervention and exercises. Sixty patients aged 25-60 years with low back pain lasting longer than 1 year after previous surgery for disc herniation were randomly allocated to the two treatment groups. Experienced back surgeons performed transpedicular fusion. Cognitive intervention consisted of a lecture intended 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 primary outcome measure was the Oswestry Disability Index (ODI). Outcome data were analyzed on an intention-to-treat basis. Ninety-seven percent of the patients, including seven of eight patients who had either not attended treatment (n=5) or changed groups (n=2), completed 1-year follow-up. ODI was significantly improved from 47 to 38 after fusion and from 45 to 32 after cognitive intervention and exercises. The mean difference between treatments after adjustment for gender was -7.3 (95% CI -17.3 to 2.7, p=0.15). The success rate was 50% in the fusion group and 48% in the cognitive intervention/exercise group. For patients with chronic low back pain after previous surgery for disc herniation, lumbar fusion failed to show any benefit over cognitive intervention and exercises.

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In a randomized study comparing the effectiveness of lumbar fusion with posterior transpedicular screw fixation, and cognitive intervention and exercises among patients with CPSP after previous surgery for disc herniation, the surgery and the combination of cognitive intervention and exercise showed similar levels of effectiveness in managing the pain.
“In a randomized study comparing the effectiveness of lumbar fusion with posterior transpedicular screw fixation, and cognitive intervention and exercises among patients with CPSP after previous surgery for disc herniation, the surgery and the combination of cognitive intervention and exercise showed similar levels of effectiveness in managing the pain [88].”
From Chronic postsurgical pain: current evidence for prevention and management (2018) · cites this paper as [88]

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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
Brox, J. I., Sørensen, R., Friis, A., Nygaard, O. P., Indahl, A., Keller, A., Ingebrigtsen, T., Eriksen, H. R., Holm, I., Koller, A. K., et al. (2003) · Spine · doi:10.1097/01.brs.0000083234.62751.7a · Cited by 623 · see citing works
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Lumbar fusion did not differ from cognitive therapy plus exercise for reducing disability and pain in chronic low back pain
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Meta-analysis of randomized trials comparing fusion surgery to non-surgical treatment for discogenic chronic low back pain
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Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials
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Self-citation

Authors: Brox, J. I., Reikerås, O., Nygaard, Y., Srensen, R., Indahl, A., Holm, I., Keller, A., Ingebrigtsen, T., Grundnes, O., Lange, J. E., & Friis, A.
Affiliations: Oslo University Hospital (NO)
St Olav's University Hospital (NO)
University Hospital of North Norway (NO)
Corresponding author: Brox, Jens Ivar
ORCID: Brox, Jens Ivar
Holm, Inger
Ingebrigtsen, Tor
Grundnes, Oliver
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2006-05
Volume: 122
Issue: 1
Pages: 145-155
ISSN: 0304-3959 (ISSN-L)
DOI: 10.1016/j.pain.2006.01.027
OpenAlex: W2089860017
Cited by: 296
References: 54
Citations by year: 2026: 3 · 2025: 7 · 2024: 6 · 2023: 5 · 2022: 7 · 2021: 12 · 2020: 9 · 2019: 19 · 2018: 14 · 2017: 14 · 2016: 13 · 2015: 24 · 2014: 26 · 2013: 28 · 2012: 22
FWCI: 10.67
Type: journal article
Language: en
Open access: closed
Locations: Pain (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Surgery › Cervical and Thoracic Myelopathy
Keywords: lumbar fusion, chronic low back pain, disc herniation, failed back surgery syndrome, cognitive intervention, physical activity, pedicle screw, Oswestry Disability Index
MeSH terms: Adult, Back Pain, Chronic Disease, Exercise Therapy, Female, Humans, Intervertebral Disc Displacement, Lumbar Vertebrae, Male, Middle Aged, Norway, Prognosis, Prospective Studies, Risk Factors, Spinal Fusion, Comorbidity, Cognitive Behavioral Therapy, Incidence, Treatment Outcome, Risk Assessment

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Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: A prospective randomized controlled study

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