POEMs

Lumbar Fusion No Better Than Exercise and Therapy in the Long Term

 

Am Fam Physician. 2016 Dec 1;94(11):937.

Clinical Question

Is lumbar fusion effective for patients with chronic low back pain?

Bottom Line

This trial is a good example of how to do just about everything wrong to get the results you want. The authors did not conceal allocation, did not mask anyone in the study, used an unvalidated and subjective primary outcome, and downplayed the intention-to-treat analysis. Funding for the original study came from industry, and the authors have numerous conflicts of interest. Two other trials in the United Kingdom and Norway found no benefit to lumbar fusion, and the results of this study are consistent with those findings, despite what the authors conclude. (Level of Evidence = 2b)

Synopsis

This is an important question—one not without controversy. This study reports a mean 12.8 years of follow-up from

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


 

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