Don’t perform fusion surgery to treat patients with mechanical axial low back pain from multilevel spine degeneration in the absence of: – leg pain with or without neurologic symptoms and/or signs of concordant neurologic compression – structural pathology such as spondylolisthesis or deformity.

For over half a century back pain has been the most common reason for spinal fusion. Yet there is no unequivocal evidence that fusion is superior to comprehensive conservative treatment for treating back pain without focal structural pathology and concordant mechanical or neurological symptoms. It is often impossible to locate the precise source of the pain; in many cases the symptoms are multifactorial and can encompass elements such as centralized pain that exist outside the spine. The extreme heterogeneity of the low back pain population leads to unpredictable surgical results and consistently poor outcomes in those with pain from multilevel spine degeneration.

 

Sources:

Chou R, et al. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976). 2009 May 1;34(10):1094-109. PMID: 19363455.

Jacobs WC, et al. Evidence for surgery in degenerative lumbar spine disorders. Best Pract Res Clin Rheumatol. 2013 Oct;27(5):673-84. PMID: 24315148.