Recommendation ID

Spinal fusion:- Should people with low back pain be offered spinal fusion as a surgical option?

Any explanatory notes
(if applicable)

Why this is important:- An increasing number of procedures have been proposed for surgically managing low back pain. One of these procedures is surgical fixation with internal metalwork applied from the back, front, side, or any combination of the 3 routes. The cost of these operations has risen, and now that minimally invasive approaches are used, more of these operations are done with uncertain benefit.
As well as the cost, surgery can lead to complications – some studies report around a 20% complication rate in the short to medium term. There have been several studies (both randomised and cohort) looking at the clinical effectiveness of spinal fusion versus usual care, no surgery, different surgeries, and other treatments. Overall, the studies do not show a clear advantage of fusion but do show some modest benefit for some elements of pain, function and quality of life. The studies also show healthcare use was lower. It is not known what treatments should be tried before surgery is considered. The evidence from the studies was weak because of low numbers of patients, large crossover and in-case selection bias. This means there is a need for a large, multicentre randomised trial with sufficient power to answer these important questions.

Source guidance details

Comes from guidance
Low back pain and sciatica in over 16s: assessment and management
Date issued
November 2016

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 30/11/2016