2001 Volvo Award Winner in Clinical Studies: Lumbar Fusion versus Nonsurgical Treatment for Chronic Low Back Pain: A Multicenter Randomized Controlled Trial from the Swedish Lumbar Spine Study Group *

This chapter aims to determine if lumbar fusion could reduce pain and disability greater than nonsurgical treatment in patients with chronic low back pain. Pain, disability, global self-rating, and return to work were used as primary outcome measures. The nonsurgical group involved treatment primarily with physical therapy, but other forms of treatment were allowed, including education, transcutaneous electrical nerve stimulation (TENS), acupuncture, injections, cognitive/functional training, and coping strategies. The treatment received could vary significantly, but all were within commonly used treatment paradigms. The investigators thus established two groups, surgical and nonsurgical. The surgical group was treated by any one of 26 experienced spine surgeons. The chapter addresses an important question regarding surgical intervention versus continued nonsurgical management for disabling chronic lower back pain. The Swedish Lumbar Spine Study Group included several different techniques for surgical intervention, including posterolateral fusion, fusion with pedicle screws, and interbody fusion with pedicle screw placement.