Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 59. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Degenerative Lumbar Spondylosis Chapter 20 569 The Swedish Lumbar Spine Study 88-91 investigated whether lumbar fusion could reduce pain and diminish disability more effectively when compared with non-surgical treatment in patients with severe chronic low-back pain CLBP . The surgical patients had a significantly higher rate of subjective favorable outcome and return to work rate compared to the non-surgical group. However no significant differences between fusion techniques were found among the groups in terms of subjective or objective clinical outcome 91 . The authors concluded from their studies that lumbar fusion in a well-informed and selected group of patients with severe CLBP can diminish pain and decrease disability more efficiently than commonly used non-surgical treatment and that there was no obvious disadvantage in using the least demanding surgical technique of posterolateral fusion without internal fixation 90 91 . The results of this study were analyzed in the context of cost-effectiveness. For both the society and the healthcare sectors the 2-year costs for lumbar fusion were significantly higher compared with non-surgical treatment but all treatment effects were significantly in favor of surgery 88 . Longer term follow-up however revealed that the benefits of surgery diminished over time P. Fritzell personal communication . Although this study was highly acclaimed for being the first of its kind criticism arose with regard to the patient inclusion criteria . sick leave for at least 1 year and the non-specified conservative treatment 103 . In a single blinded RCT from Norway 31 151 the effectiveness of lumbar instrumented fusion was compared with cognitive intervention and exercises in patients with chronic low-back pain and disc degeneration. No significant differences were found in terms of subjective outcome or disability. Patients with chronic low-back pain who followed cognitive intervention and exercise programmes improved significantly in
