Review: lumbar fusion versus nonsurgical treatment for chronic low back pain

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I wonder where things stand now w/newer fusion methods.

A comment:

A review of the 2001 volvo award winner in clinical studies : Lumbar fusion versus nosurgical treatment for chronic low back pain: A multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group

[mmglobal]

ans,

My guess is that it's similar to where it was when these papers were published. I don't believe the answer is in the data. We still see people presenting 25% screw loosening with Dynesys, while others with large Dynesys experience present almost nil.

I believe that we can't sort out the biases in the numbers.

>> reported correctly?

>> cherry picking surgeons vs. those who take on the tough cases?

>> talent difference?

>> System / hardware differences?

Last night, I was speaking to someone who is considering XLIF fusion at L4-5. Where he lives, experience w/XLIF is quite limited, but starting to become availalbe. I told him that I'd rather have an excellent PLIF or TLIF than a bad XLIF.

I belive the same thing for fusions that I do for ADR. If you are a good candidate and get a good job done, it doesn't matter which system or approach is used. Obviously, there are some issues that will make us want to move towards techniques that are more promising, but new techniques may still have hidden issues. Most importantly, there are issues and potential problems that are not represented in the data. Interesting discussion,

Mark

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As usual, excellent points Mark. Thanks..