• Jens Ivar Brox, Øystein P Nygaard, Inger Holm, Anne Keller, Tor Ingebrigtsen, and Olav Reikerås.
• Orthopaedic Department, Oslo University Hospital-Rikshospitalet, Sognsvannsveien, 0027 Oslo, Norway. jens.ivar.brox@rikshospitalet.no
• Ann. Rheum. Dis. 2010 Sep 1; 69 (9): 1643-8.

ObjectivesTo compare the long-term effectiveness of surgical and non-surgical treatment in patients with chronic low back pain.MethodsTwo merged randomised clinical trials compared instrumented transpedicular fusion with cognitive intervention and exercises in 124 patients with disc degeneration and at least 1 year of symptoms after or without previous surgery for disc herniation. The main outcome measure was the Oswestry disability index.ResultsAt 4 years 14 (24%) patients randomly assigned to cognitive intervention and exercises had also undergone surgery. 15 (23%) patients assigned fusion had undergone re-surgery. The mean treatment effect for the primary outcome was 1.1; 95% CI -5.9 to 8.2, according to the intention-to-treat analysis and -1.6; 95% CI -8.9 to 5.6 in the as-treated analysis. There was no difference in return to work.ConclusionsLong-term improvement was not better after instrumented transpedicular fusion compared with cognitive intervention and exercises.

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