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Surgical versus nonsurgical treatment of chronic low back pain: A meta-analysis based on current evidence.

BACKGROUND
There are still no clearly defined clinical-practice guidelines related to surgical intervention for chronic low back pain (CLBP) in the absence of serious structural problems such as instability, spinal stenosis, spondylolysis, infection, or neoplasm. There is also a lack of high-quality evidence regarding CLBP treatment.


OBJECTIVE
To compare the clinical effectiveness of lumbar surgery vs. nonsurgical treatment for chronic low back pain.


METHODS
A search was conducted using MEDLINE®, Embase, and reference lists of articles and personal files. After a systematic search, studies were selected on the basis of inclusion criteria. Six articles (904 patients) met the inclusion criteria for the study. Pooled estimates of clinical results were calculated with 95% confidence intervals.


RESULTS
All six eligible studies were independent randomized clinical trials. Pooled data revealed that, compared with surgical treatment, nonsurgical treatment was associated with better Oswestry Disability Index scores. Both groups had similar Visual Analogue Scale and Emotional Distress Scale scores as well as General Function Scores.


CONCLUSIONS
For chronic low back pain, nonsurgical treatment was shown to be effective, feasible, and safe during the follow-up period. More randomized controlled trials are needed to compare surgical and nonsurgical treatment of chronic low back pain.