Chronic Low Back Pain - Physiotherapy or Spondylodesis to Reduce Pain and Disability Systematic Review

Background: Eighty per cent of Swiss citizens suffer of low back pain (LBP) at least once a year. It is unclear whether spondylodesis or conservative therapy (physiotherapy) is more effective in chronic LBP (CLBP). Objective: Comparison of treatment effects of conservative therapy (physiotherapy) and spondylodesis in CLBP (specific and nonspecific) related to pain and disability. Method: This systematic review following literature search was performed in Pubmed, PEDro, Co-chrane and CINAHL, the risk of bias analysis using PEDro criteria (>= 6/10 = good). Results: 10 out of 82 publications fulfilled all inclusion criteria and were related to 4 studies. 3 out of the 4 studies had a low risk of bias. 2 studies investigated patients with disc degeneration or CLBP more than 1 year after disc herniation surgery. The outcome showed no difference between spondylodesis and conservative therapy (physiotherapy with cognitive therapy) after 1, 4 and 9 years. A third study with a higher risk of bias demonstrated a statistically significant but not clinically relevant advantage of spondylodesis after 2 years. According to the 4th study in patients with isthmic spondylolisthesis after 2 years spondylodesis was more effective than conservative therapy (physiotherapy with cognitive therapy). After 5 - 13 years there was no outcome difference. Conclusions: In CLBP due to discogenic causes conservative therapy (physiotherapy with cognitive therapy) is as effective as spondylodesis in reducing pain and disability. In the case of CLBP in isthmic spondylolisthesis spondylodesis is more effective than physiotherapy up to 2 years following intervention whereas there is no difference between both interventions with respect to pain and disability after 9 years on average.