Consensus at last! Long-term results of all randomized controlled trials show that fusion is no better than non-operative care in improving pain and disability in chronic low back pain

Mannion, Anne F.; Brox, Jens-Ivar; Fairbank, Jeremy C.

doi:10.1016/j.spinee.2015.12.001

Cited by 55Spine and Intervertebral Disc PathologyMusculoskeletal pain and rehabilitationPain Management and Treatment

Consensus at last! Long-term results of all randomized controlled trials show that fusion is no better than non-operative care in improving pain and disability in chronic low back pain

Mannion, Anne F., Brox, Jens-Ivar, Fairbank, Jeremy C.·2016·The Spine Journal

DOI 10.1016/j.spinee.2015.12.001

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Abstract

Commentary On: Hedlund R, Johansson C, Hagg O, Fritzell P, Tullberg T. Swedish Lumbar Spine Study Group. The long-term outcome of lumbar fusion in the Swedish lumbar spine study. Spine J 2016;16:579-87 (in this issue).

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Traditional biomedical interventions such as surgery and spinal injections have not been shown to be superior to conservative treatments for chronic pain and carry greater risks.
“Traditional biomedical interventions, such as surgery and spinal injections, have not been shown to be superior to conservative treatments for chronic pain and they carry greater risks [7, 8].”
From Exercise combined with Acceptance and Commitment Therapy (ExACT) compared to a supervised exercise programme for adults with chronic pain: study protocol for a randomised controlled trial. (2018) · cites this paper as [7]

Chapter 4 European guidelines for the management of chronic nonspecific 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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The long-term outcome of lumbar fusion in the Swedish lumbar spine study
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“…surgery, a surgery commonly performed for a diagnosis of degeneration, provides no benefit over safer and less costly approaches such as exercise (Mannion et al., 2016) yet the US spends more money on spinal fusion each year than any other surgery (US$12.8 billion per annum) and it is the fourth…”
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“These patients may then receive expensive health care services that provide minimal benefit or potentially cause harm, such as opioids and spinal fusion surgery.(2,10,12,13) SCS therapy creates a neuromodulatory effect on the nervous system that can change the perception of pain by sending electrical impulses into the…”
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“27 28 – 30 Despite stated limitations, these surgeries are becoming more frequent and are speculated to continue to increase drastically in the coming years.”
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“However, more recent studies have shown that spinal fusion is not superior to non-surgical treatment based on the long-term outcomes of pain and disability in patients with chronic LBP [3].”
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“…superior [1,5], whereas three reported that both treatments produced only modest improvement [2 – 4]; however, a more detailed analysis found less clear differences among the studies [6 – 8] and at 10-11 years [9,10] fusion surgery for CLBP was no better than structured non-surgical treatment [11].”
CHRONIC LOW BACK PAIN: A REVIEW OF DIAGNOSTIC ALGORITHMS, PATHOPHYSIOLOGICAL MECHANISMS, AND EVIDENCE-BASED MANAGEMENT IN PRIMARY CARE
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Mirza, S. K., & Deyo, R. A. (2007) · Spine · doi:10.1097/01.brs.0000259225.37454.38 · Cited by 347 · see citing works
Fusion surgery is slightly better than non-surgical treatment in patients with severe chronic non-specific low back pain
Holm, I. (2002) · Australian Journal of Physiotherapy · doi:10.1016/s0004-9514(14)60208-7 · Cited by 7 · see citing works

Authors: Mannion, A. F., Brox, J.-I., & Fairbank, J. C.
Affiliations: Schulthess-Klinik (CH)
Oslo University Hospital (NO)
Nuffield Orthopaedic Centre (GB)
Corresponding author: Mannion, Anne F.
ORCID: Mannion, Anne F.
Brox, Jens-Ivar
Fairbank, Jeremy C.
Venue: The Spine Journal
Publisher: Elsevier BV
Published: 2016-05
Volume: 16
Issue: 5
Pages: 588-590
ISSN: 1529-9430 (ISSN-L)
DOI: 10.1016/j.spinee.2015.12.001
OpenAlex: W2418509179
Cited by: 55
References: 16
Citations by year: 2026: 4 · 2025: 5 · 2024: 6 · 2023: 2 · 2022: 5 · 2021: 6 · 2020: 6 · 2019: 3 · 2018: 9 · 2017: 5 · 2016: 4
FWCI: 6.36
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Spine Journal (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 › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: lumbar fusion, chronic low back pain, long-term outcomes, pain and disability, randomized controlled trials
MeSH terms: Humans, Lumbar Vertebrae, Spinal Fusion, Randomized Controlled Trials as Topic, Treatment Outcome, Low Back Pain, Consensus

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Consensus at last! Long-term results of all randomized controlled trials show that fusion is no better than non-operative care in improving pain and disability in chronic low back pain

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