• Anne Froholdt, Inger Holm, Anne Keller, Ragnhild B Gunderson, Olav Reikeraas, and Jens I Brox.
• Division of Orthopedic Surgery, Department of Orthopedics, Oslo University Hospital, Rikshospitalet, Pb 4950 Nydalen, 0424 Oslo, Norway. anne.froholdt@ous-hf.no
• Spine J. 2011 Aug 1;11(8):718-25.

Background ContextReduced muscle strength and density observed at 1 year after lumbar fusion may deteriorate more in the long term.PurposeTo compare the long-term effect of lumbar fusion and cognitive intervention and exercises on muscle strength, cross-sectional area, density, and self-rated function in patients with chronic low back pain (CLBP) and disc degeneration.Study DesignRandomized controlled study with a follow-up examination at 8.5 years (range, 7-11 years).Patients And MethodsPatients with CLBP and disc degeneration randomized to either instrumented posterolateral fusion of one or both of the two lower lumbar levels or a 3-week cognitive intervention and exercise program were included. Isokinetic muscle strength was measured by a Cybex 6000 (Cybex-Lumex, Inc., Ronkonkoma, NY, USA). All patients had previous experience with the test procedure. The back extension (E) flexion (F) muscles were tested, and the E/F ratios were calculated. Cross-sectional area and density of the back muscles were measured at the L3-L4 segment by computed tomography. Patients rated their function by the General Function Score.Outcome MeasuresTrunk muscle strength, cross-sectional area, density, and self-rated function.ResultsFifty-five patients (90%) were included at long-term follow-up. There were no significant differences in cross-sectional area, density, muscle strength, or self-rated function between the two groups. The cognitive intervention and exercise group increased trunk muscle extension significantly (p<.05), and both groups performed significantly better on trunk muscle flexion tests (p<.01) at long-term follow-up. On average, self-rated function improved by 56%, cross-sectional area was reduced by 8.5%, and muscle density was reduced by 27%.ConclusionAlthough this study did not assess the morphology of muscles likely damaged by surgery, trunk muscle strength and cross-sectional area above the surgical levels are not different between those who had lumbar fusion or cognitive intervention and exercises at 7- to 11-year follow-up.Copyright © 2011 Elsevier Inc. All rights reserved.

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