Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis

The utilization of pedicle screw fixation as an adjunct to posterolateral lumbar fusion (PLF) has become routine, but demonstration of a definitive benefit remains problematic. The medical evidence indicates that the addition of pedicle screw fixation to PLF increases fusion rates when assessed with dynamic radiographs. More recent evidence, since publication of the 2005 Lumbar Fusion Guidelines, suggests a stronger association between radiographic fusion and clinical outcome, although, even now, no clear correlation has been demonstrated. Although several reports suggest that clinical outcomes are improved with the addition of pedicle screw fixation, there are conflicting findings from similarly classified evidence. Furthermore, the largest contemporary, randomized, controlled study on this topic failed to demonstrate a significant clinical benefit with the use of pedicle screw fixation in patients undergoing PLF for chronic low-back pain. This absence of proof should not, however, be interpreted as proof of absence. Several limitations continue to compromise these investigations. For example, in the majority of studies the sample size is insufficient to detect small increments in clinical outcome that may be observed with pedicle screw fixation. Therefore, no definitive statement regarding the efficacy of pedicle screw fixation as a means to improve functional outcomes in patients undergoing PLF for chronic low-back pain can be made. There appears to be consistent evidence suggesting that pedicle screw fixation increases the costs and complication rate of PLF. High-risk patients, including (but not limited to) patients who smoke, patients who are undergoing revision surgery, or patients who suffer from medical conditions that may compromise fusion potential, may appreciate a greater benefit with supplemental pedicle screw fixation. It is recommended, therefore, that the use of pedicle screw fixation as a supplement to PLF be reserved for those patients in whom there is an increased risk of nonunion when treated with only PLF.

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Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: Lumbar fusion for disc herniation and radiculopathy

Journal of Neurosurgery Spine ◽

10.3171/2014.4.spine14271 ◽

2014 ◽

Vol 21 (1) ◽

pp. 48-53 ◽

Cited By ~ 34

Author(s):

Jeffrey C. Wang ◽

Andrew T. Dailey ◽

Praveen V. Mummaneni ◽

Zoher Ghogawala ◽

Daniel K. Resnick ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Lumbar Fusion ◽

Signs And Symptoms ◽

Herniated Disc ◽

Spinal Instability ◽

Low Back ◽

Low Level ◽

Disc Herniations

Patients suffering from a lumbar herniated disc will typically present with signs and symptoms consistent with radiculopathy. They may also have low-back pain, however, and the source of this pain is less certain, as it may be from the degenerative process that led to the herniation. The surgical alternative of choice remains a lumbar discectomy, but fusions have been performed for both primary and recurrent disc herniations. In the original guidelines, the inclusion of a fusion for routine discectomies was not recommended. This recommendation continues to be supported by more recent evidence. Based on low-level evidence, the incorporation of a lumbar fusion may be considered an option when a herniation is associated with evidence of spinal instability, chronic low-back pain, and/or severe degenerative changes, or if the patient participates in heavy manual labor. For recurrent disc herniations, there is low-level evidence to support the inclusion of lumbar fusion for patients with evidence of instability or chronic low-back pain.

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Intervertebral disc therapies for non-specific chronic low back pain: a systematic review and meta-analysis

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x211028001 ◽

2021 ◽

Vol 13 ◽

pp. 1759720X2110280

Author(s):

Camille Daste ◽

Stéphanie Laclau ◽

Margaux Boisson ◽

François Segretin ◽

Antoine Feydy ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Activity Limitations ◽

Low Back ◽

Short Term

Objectives: We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). Methods: We conducted a systematic review and meta-analysis of randomized trials of IDTs versus placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week–3 months), intermediate term (3–6 months) and long term (after 6 months). Results: Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept ( n = 2), tocilizumab ( n = 1), methylene blue ( n = 2), ozone ( n = 2), chymopapaine ( n = 1), glycerol ( n = 1), stem cells ( n = 1), platelet-rich plasma ( n = 1) and recombinant human growth and differentiation factor-5 ( n = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were −1.33 (−2.34; −0.32) and −0.76 (−1.85; 0.34) at short term, −2.22 (−5.34; 0.90) and −1.60 (−3.51; 0.32) at intermediate term and −1.11 (−2.91; 0.70) and −0.63 (−1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91). Conclusion: GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies. Registration PROSPERO: CRD42019106336.

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Intraosseous Radiofrequency Ablation of the Basivertebral Nerve in Chronic Low Back Pain: A Meta-Analysis

Open Journal of Radiology ◽

10.4236/ojrad.2021.113008 ◽

2021 ◽

Vol 11 (03) ◽

pp. 81-90

Author(s):

Alistair J. Loan ◽

David C. Kieser

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Radiofrequency Ablation ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Low Back

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Effect of the duration of chronic low back pain on pain sensitivity of patients undergoing lumbar fusion surgery

Pain medicine ◽

10.31636/pmjua.v5i4.2 ◽

2021 ◽

Vol 5 (4) ◽

pp. 8-15

Author(s):

Mei-ping Qian ◽

Mei-rong Dong ◽

Fang Kang ◽

Juan Li

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Hospital Stay ◽

Chronic Low Back Pain ◽

Pain Sensitivity ◽

Lumbar Fusion ◽

Low Back ◽

Fusion Surgery ◽

Lumbar Fusion Surgery

Background: chronic low back pain is a serious social problem. In recent years, patients who choose lumbar fusion surgery due to chronic low back pain has been increasing. Pre-existing chronic pain has been associated with severe postoperative pain. In this study, we have sought to prospectively analyze the association between the duration of chronic low back pain and pain sensitivity after lumbar fusion surgery. Methods: 400 patients who underwent lumbar fusion surgery were divided into three groups based on the duration of chronic pain. During the first postoperative day, the maximum pain scores of each patient day and night, the pain scores at the day of discharge, the consumption of postoperative analgesics and the length of hospital stay were recorded. Results: of 400 patients recruited, 369 patients completed the experiment. There was no significant difference in gender, age, height, weight, pre-operative pain at rest, and operation time in the three groups. During the day, the pain sensitivity of the three groups were 1.71 ± 0.66, 2.40 ± 0.74, 2.90 ± 0.80. During the night, the pain sensitivity of the three groups were 3.45 ± 0.81, 4.31 ± 1.06, 4.86 ± 1.05. At the day of discharge, the pain sensitivity of three groups were 1.26 ± 0.46, 1.47 ± 0.58, 1.96 ± 0.64. There were significant differences in pain sensitivity among the three groups during the day and night on the first postoperative day and at the day of discharge (p < 0.05). The length of hospital stay (7.31 ± 1.36 days, 8.82 ± 1.48 days, 9.60 ± 1.61 days) and analgesic consumption (25.04 ± 36.56 mg, 33.52 ± 24.04 mg, 45.15 ± 24.89 mg, morphine equivalent) were also significant differences (p < 0.05). Conclusion: we found the duration of chronic low back pain before lumbar fusion surgery affects patient’ postoperative pain sensitivity, consumption of analgesic drugs and hospital stay. The longer the preoperative chronic pain lasts, the higher the postoperative VAS score is, the more analgesic drugs were consumed, and the longer hospital stay is.

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Extracorporeal shockwave therapy for treating chronic low-back pain: a protocol of a systematic review and meta-analysis of randomized controlled trials

10.37766/inplasy2021.4.0100 ◽

2021 ◽

Author(s):

Lei Yue ◽

Mingshuai Sun ◽

Meixia Shang ◽

Haolin Sun

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Controlled Trials ◽

Low Back ◽

Extracorporeal Shockwave Therapy ◽

Shockwave Therapy ◽

Randomized Controlled

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Acupuncture Therapy in Reducing Pain in Patients with Low Back Pain: Meta Analysis

Childhood Stunting, Wasting, and Obesity, as the Critical Global Health Issues: Forging Cross-Sectoral Solutions ◽

10.26911/the7thicph.05.43 ◽

2020 ◽

Author(s):

Elisa Novitasari ◽

◽

RB. Soemanto ◽

Hanung Prasetya ◽

◽

...

Keyword(s):

Randomized Controlled Trial ◽

Low Back Pain ◽

Back Pain ◽

Acupuncture Therapy ◽

Chronic Low Back Pain ◽

Controlled Trial ◽

Meta Analysis ◽

Low Back ◽

Randomized Controlled ◽

Keywords Low Back Pain

ABSTRACT Background: With growing evidence of high prevalence in developing countries, LBP is no longer recognized as a disorder confined to high-income nations but is a major health problem globally. The functional limitations and consequent disability create a heavy economic burden on individuals and society. This study aimed to acupuncture therapy in reducing pain in patients with low back pain. Subjects and Method: A meta-analysis and systematic review was conducted by search published articles from PubMed, Google Schoolar, Mendeley, Hindawi, and Clinical key databases. Keywords used “acupuncture low back pain” OR “acupuncture chronic pain” AND “efficacy acupuncture” AND “chronic low back pain” AND “effect acupuncture for low back pain” AND “randomized controlled trial” AND “visual analogue scale”. The inclusion criteria were full text and using randomized controlled trial (RCT) study design. The articles were selected by PRISMA flow chart and the quantitative data were analyzed by Revman 5.3. Results: 7 studies were met criteria. This study showed that acupuncture therapy reduced pain in patients with low back pain (Mean Difference= -0.40; 95% CI= -0.80 to 0.01; p= 0.05) with heterogeneity I2= 83%. Conclusion: Acupuncture therapy reduces pain in patients with low back pain. Keywords: low back pain, acupuncture chronic low back pain, randomized controlled trial. Correspondence: Elisa Novitasari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: [email protected]. Mobile: 085727851938. DOI: https://doi.org/10.26911/the7thicph.05.43

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