Chronic low back pain: Relevance of a new classification based on the injury pattern

The objectives of this study were to define the role for surgery in the treatment of chronic low back pain (cLBP) and to develop a new classification of cLBP based on the pattern of injury.HypothesisSurgery may benefit patients with cLBP, and a new classification based on the injury pattern may be of interest.MethodA systematic literature review was performed by searching Medline, the Cochrane Library, the French public health database (Banque de Données en Santé Publique), Science Direct, and the National Guideline Clearinghouse. The main search terms were “back pain” OR “lumbar” OR “intervertebral disc replacement” OR “vertebrae” OR “spinal” AND “surgery” OR “surgical” OR “fusion” OR “laminectomy” OR “discectomy”.ResultsSurgical techniques available for treating cLBP consist of fusion, disc replacement, dynamic stabilisation, and inter-spinous posterior devices. Compared to non-operative management including intensive rehabilitation therapy and cognitive behavioural therapy, fusion is not better in terms of either function (evaluated using the Oswestry Disability Index [ODI]) or pain (level 2). Fusion is better than non-operative management without intensive rehabilitation therapy (level 2). There is no evidence to date that one fusion technique is superior over the others regarding the clinical outcomes (assessed using the ODI). Compared to fusion or multidisciplinary rehabilitation therapy, disc replacement can produce better func...
Source: Orthopaedics and Traumatology: Surgery and Research - Category: Orthopaedics Source Type: research