Interdisciplinary Neurosurgery · Published 2026-07-15 · DOI 10.1016/j.inat.2026.102317
Bo Nyström, Birgitta Schillberg, Per Lundin, Tore C. Stiles, Shaobo Jin
Background: Fusion surgery is not found to be superior to non-surgical treatment in chronic low back pain (CLBP), an “umbrella” diagnosis including unidentified subgroups.We used previously reported clinical characteristics to improve the selection of fusion candidates and a novel provocation test to establish the spinal pain locus. Patients were randomized to fusion surgery + exercise and cognitive-behavior therapy (CBT) (Group S), vs only exercise + CBT (Group NS). Methods: Of 192 eligible patients 74 agreed to participate. Symptoms were analyzed, the patients examined clinically, including local back signs, along with X-ray, MRI, discography, discoblock, and mechanical provocation tests. Specific disc degeneration was not required. Exercise started during a 5-days-stay at the clinic, continuing at home, along with seven sessions of CBT. The surgery was a posterior lumbar interbody fusion. Outcome was assessed by the BIS, back pain VAS, ODI, Roland Morris, SF-36 and EQ-5D questionnaires. Statistical methods for detecting differences in ordinal data were used. Results: At the one-year follow-up 81% and 16% of the patients in Group S and NS, respectively, assessed lower levels of back pain (BIS questionnaire). The ODI score at study start/follow-up was 45/17 (Group S), 46/44 (Group NS), the Roland Morris score 12.8/3.5 and 13.4/11.9, and back pain VAS (median) 66/7 vs 64/74, respectively. The SF-36 and EQ-5D analyses also markedly favored Group S. Outcome was unrelated to disc degeneration. Conclusion: For appropriately selected CLBP patients, fusion surgery was found effective.but conservative treatment was not.
Abstract from DOAJ. Public domain (CC0 1.0).
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Nyström, B., Schillberg, B., Lundin, P., et al. (2026). Clinical selection of segmental/discogenic pain patients: In a randomized trial, fusion surgery was effective, but not non-surgical treatment. Interdisciplinary Neurosurgery. https://doi.org/10.1016/j.inat.2026.102317