Cited by 514Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyPain Management and Treatment

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Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial

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Fairbank, Jeremy, Frost, Helen, Wilson-MacDonald, James, Yu, Ly-Mee, Barker, Karen, Collins, Rory·2005·BMJ

DOI 10.1136/bmj.38441.620417.8fPMC PMC558090

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Abstract

OBJECTIVES: To assess the clinical effectiveness of surgical stabilisation (spinal fusion) compared with intensive rehabilitation for patients with chronic low back pain. DESIGN: Multicentre randomised controlled trial. SETTING: 15 secondary care orthopaedic and rehabilitation centres across the United Kingdom. PARTICIPANTS: 349 participants aged 18-55 with chronic low back pain of at least one year's duration who were considered candidates for spinal fusion. INTERVENTION: Lumbar spine fusion or an intensive rehabilitation programme based on principles of cognitive behaviour therapy. MAIN OUTCOME MEASURE: The primary outcomes were the Oswestry disability index and the shuttle walking test measured at baseline and two years after randomisation. The SF-36 instrument was used as a secondary outcome measure. RESULTS: 176 participants were assigned to surgery and 173 to rehabilitation. 284 (81%) provided follow-up data at 24 months. The mean Oswestry disability index changed favourably from 46.5 (SD 14.6) to 34.0 (SD 21.1) in the surgery group and from 44.8 (SD14.8) to 36.1 (SD 20.6) in the rehabilitation group. The estimated mean difference between the groups was -4.1 (95% confidence interval -8.1 to -0.1, P = 0.045) in favour of surgery. No significant differences between the treatment groups were observed in the shuttle walking test or any of the other outcome measures. CONCLUSIONS: Both groups reported reductions in disability during two years of follow-up, possibly unrelated to the interventions. The statistical difference between treatment groups in one of the two primary outcome measures was marginal and only just reached the predefined minimal clinical difference, and the potential risk and additional cost of surgery also need to be considered. No clear evidence emerged that primary spinal fusion surgery was any more beneficial than intensive rehabilitation.

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Competing interests: none declared.
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Nuffield Orthopaedic Centre, Oxford OX3 7LD Jeremy Fairbank consultant orthopaedic surgeon James Wilson-MacDonald consultant orthopaedic surgeon Karen Barker director of physiotherapy research University of Warwick, Division of Health in the Community, Coventry CV4 7AL Helen Frost research fellow Centre for Statistics in Medicine, Oxford OX3 7LF Ly-Mee Yu statistician Clinical Trial Service Unit and Epidemiological Studies Unit, Radcliffe Infirmary, Oxford OX2 6HE Rory Collins professor Correspondence to: J Fairbank jeremy.fairbank@ndos.ox.ac.uk

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“A recent study compared outcomes of surgical and rehabilitation-based interventions for chronic low back pain [48].”
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“In the studies by Brox et al [10] and Fairbank et al [11], patients undergoing extensive programs of exercise therapy based on cognitive behavioral principles, and delivered in a group setting, had equivalent outcomes to those undergoing lumbar fusion.”
Result
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BackgroundResultInfluential
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To the Editor
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Comparative effectiveness and safety of herbal medicine therapy for low back pain and radiculopathy caused by lumbar intervertebral disc herniation: a study protocol for a pragmatic randomized controlled trial
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Authors: Fairbank, J., Frost, H., Wilson-MacDonald, J., Yu, L.-M., Barker, K., & Collins, R.
Affiliations: Nuffield Orthopaedic Centre (GB)
University of Warwick (GB)
University of Oxford (GB)
Corresponding author: Fairbank, Jeremy
ORCID: Fairbank, Jeremy
Frost, Helen
Yu, Ly-Mee
Barker, Karen
Collins, Rory
Venue: BMJ
Publisher: BMJ
Published: 2005-05-23
Volume: 330
Issue: 7502
Pages: 1233
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.38441.620417.8f
PMC: PMC558090
OpenAlex: W2117632584
Cited by: 514
References: 43
Citations by year: 2026: 9 · 2025: 12 · 2024: 9 · 2023: 11 · 2022: 16 · 2021: 11 · 2020: 8 · 2019: 18 · 2018: 11 · 2017: 25 · 2016: 25 · 2015: 31 · 2014: 25 · 2013: 38 · 2012: 28
FWCI: 25.95
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.bmj.org/licenses/tdm/1.0/terms-and-conditions.html (tdm)
Locations: BMJ (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by-nc)
Stirling Online Research Repository (University of Stirling) (submittedVersion, cc-by-nc)
Research Output (Edinburgh Napier University) (submittedVersion, cc-by)
HighWire Press Open Archive (submittedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: chronic low back pain, lumbar fusion, spinal stabilization, intensive rehabilitation, cognitive behavioral therapy, Oswestry Disability Index, disability, walking capacity, SF-36
MeSH terms: Adolescent, Adult, Chronic Disease, Female, Humans, Male, Middle Aged, Patient Compliance, Spinal Fusion, Cognitive Behavioral Therapy, Treatment Outcome, Low Back Pain

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Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial

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