Spinal fusion surgery has only modest, if any, effects

The optimal management of patients with chronic low back pain remains a big challenge for today's healthcare services. In this week's BMJ Fairbank et al report how they assessed the effectiveness of surgical stabilisation of the spine compared to an intensive rehabilitation programme for patients who had had low back pain of at least a year and who were considered candidates for spinal fusion.1 The authors found no clear evidence that primary spinal fusion surgery was more beneficial than intensive rehabilitation, supporting the idea that spinal fusion plays, at best, only a small role in managing chronic low back pain.

The relevant and informative randomised trial by Fairbank et al was pragmatic by design.1 Patients with chronic low …