A misreading of the evidence?

doi:10.1136/bmj.b2733

Published 8 July 2009, doi:10.1136/bmj.b2733
Cite this as: BMJ 2009;339:b2733

Letters

NICE on back pain

A misreading of the evidence?

The first 150 words of the full text of this article appear below.

In their reply to rapid responses about the guideline from theNational Institute for Health and Clinical Excellence (NICE)on persistent non-specific low back pain,¹ Underwood and Littlejohnssay that two systematic reviews report that spinal fusion iseffective and informed the NICE low back pain guideline developmentgroup²; the group proposes referral for consideration of spinalfusion as an appropriate step in managing low back pain of lessthan 12 months’ duration.

However, the authors of the first review say:

Surgical fusion for chronic low back pain favoured a marginalimprovement in the Oswestry Disability Index (4.13) comparedto non-surgical intervention. This difference ... was not statisticallysignificant and is of minimal clinical importance. Surgery wasfound to be associated with a significant risk of complications(16%). Therefore, the cumulative evidence at the present timedoes not support routine surgical fusion for the treatment ofchronic low back . . . [Full text of this article]

Stephen P Ward, consultant in pain medicine¹

¹ Brighton and Sussex University Hospitals NHS Trust, Haywards Heath, West Sussex RH16 1UL

drspward@yahoo.co.uk