Fairbank J, Frost H, Wilson-MacDonald J, et al for the Spine Stabilisation Trial Group: Randomised controlled trial to compare surgical stabilization of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilization trial. Brit Med J 2005;330:1233-9.
Koes BW: Surgery versus intensive rehabilitation programmes for chronic low back pain. Brit Med J 2005;330;1220-1 (editorial).
In this randomized controlled trial at 15 centers across the United Kingdom, 349 subjects aged 18 to 55 years with at least a year of chronic low back pain who were considered candidates for spinal fusion received either surgery or an intensive 75-day rehabilitation program based on cognitive behavior therapy. Surgeons used a surgical technique of their choice. After 2 years, the Oswestry disability index scores improved from 46.5 to 34 in the surgery group and from 44.8 to 36.1 in the rehabilitation group. The mean difference between the groups was -4.1 (95% CI -8.1 to -0.1; p = 0.045), which barely reached statistical significance in favor of surgery. After 2 years, there were no significant differences in the shuttle walking test or any other outcome measure. Both groups reported improvement in function during the study, possibly unrelated to either intervention. There was no clear evidence that primary spinal fusion surgery was any more beneficial than intensive rehabilitation.