A new study published in Clinical Spine Surgery examines the best treatment options for chronic low back pain.
The study authors reviewed 12 randomized controlled trials as reported in the Medline and Cochrane Collaboration Library databases from 1990 to 2014. The studies included five comparing total disc replacement and fusion, one comparing TDR and cognitive behavioral therapy, five comparing fusion with exercise and CBT, and one study comparing fusion to physical therapy.
The researchers found:
1. The mixed treatment comparison studies showed the mean difference in Oswestry Disability Index score changes favored spinal fusion over exercise and cognitive behavioral therapy by two points.
2. The pooled mean difference in ODI scores favored total disc replacement when compared with exercise and cognitive behavioral therapy by 6.4 points.
3. When comparing fusion and physical therapy, the pooled mean difference favored fusion over physical therapy by 8.8 points on the ODI score.
4. Total disc replacement was favored over fusion by 4.4 points in the ODI score based on the pooled mean difference.
5. The pooled mean difference between physical therapy and structured exercise with cognitive behavioral therapy favored the latter by 6.8 points.
6. Total disc replacement was favored over physical therapy in ODI score point differential by 13.2 points.
7. There wasn't a difference between the groups in additional surgery rates.
"According to the MTC analysis, TDR may be the most effective treatment and least effective treatment for chronic low back pain," concluded the study authors. However, they noted, "This review is based on a limited number of RCT studies and does not support any one treatment modality for all patients."