Bada, E.S. orcid.org/0000-0001-9745-0769, Gardner, A.C. orcid.org/0000-0001-6532-7950, Ahuja, S. orcid.org/0000-0001-8676-6100 et al. (3 more authors) (2024) Lumbar spine fusion surgery versus best conservative care for patients with severe, persistent low back pain. Bone & Joint Open, 5 (7). pp. 612-620. ISSN 2633-1462
Abstract
Aims
People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial).
Methods
An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials.
Results
There were 72 respondents, with a response rate of 9.0%. They comprised 39 orthopaedic spine surgeons, 17 neurosurgeons, one pain specialist, and 15 allied health professionals. Most respondents (n = 61,84.7%) chose conservative care as their first-choice management option for all five case vignettes. Over 50% of respondents reported willingness to randomize three of the five cases to either surgery or BCC, indicating a willingness to participate in the future randomized trial. From the respondents, transforaminal interbody fusion was the preferred approach for spinal fusion (n = 19, 36.4%), and the preferred method of BCC was a combined programme of physical and psychological therapy (n = 35, 48.5%).
Conclusion
This survey demonstrates that there is uncertainty about the role of lumbar spine fusion surgery and BCC for a range of example patients with severe, persistent LBP in the UK.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Editors: |
|
Copyright, Publisher and Additional Information: | © 2024 Bada et al. This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https:// creativecommons.org/licenses/by-nc-nd/4.0/ |
Keywords: | Spinal fusion surgery; Low back pain; Best conservative care; Physiotherapy; Clinical trials; Disability; NIHR; lumbar fusion surgery; low back pain; spinal fusion surgery; Clinicians; randomized controlled trials; clinical trials; orthopaedic spine surgeons; surgical approaches; neurosurgeons; Transforaminal interbody fusion |
Dates: |
|
Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 06 Aug 2024 10:09 |
Last Modified: | 06 Aug 2024 10:09 |
Status: | Published |
Publisher: | British Editorial Society of Bone & Joint Surgery |
Refereed: | Yes |
Identification Number: | 10.1302/2633-1462.57.bjo-2023-0147.r1 |
Related URLs: | |
Sustainable Development Goals: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:215466 |
Download
Licence: CC-BY-NC-ND 4.0