British researchers say there's no clear evidence that spinal fusion surgery for chronic low back pain is better than intensive rehabilitation in relieving discomfort.
What's more, these surgeries may not be as cost-effective as other interventions, they add.
The study included 349 people who experienced chronic low back pain, defined as pain lasting more than a year.
Patients were divided into two groups: 176 underwent spinal fusion surgery and 173 were enrolled in an intensive rehabilitation program that included daily exercises and cognitive (mental) behavior therapy.
During the two years of the study, 38 of the patients assigned to the rehabilitation group had received surgery as well, compared with seven surgery patients who had received both treatments.
This finding seems to indicate that surgery has a slight advantage over rehabilitation. However, the study authors believe the benefit is still too small, considering the potential risk and financial expense of surgery.
The researchers say there is no clear proof that surgery is better than rehabilitation, and suggest that rehabilitation should routinely be made available to people who have chronic low back pain.
Their cost analysis also found that, on average, surgery is much more expensive per patient than rehabilitation.
However, the researchers caution, this conclusion could change if more patients who receive rehabilitation go on to require back surgery in the future.
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