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Trunk Muscle Strength, Cross-sectional Area, and Density in Patients With Chronic Low Back Pain Randomized to Lumbar Fusion or Cognitive Intervention and Exercises

Keller, Anne MD*; Brox, Jens I. MD, PhD; Gunderson, Ragnhild MD; Holm, Inger PT, PhD; Friis, Astrid PT; Reikerås, Olav MD, PhD

doi: 10.1097/01.BRS.0000103946.26548.EB
Randomized Trial

Study Design.  A randomized study.

Objectives.  To compare muscle strength, cross-sectional area, and density of the back muscles in two categories of patients with chronic low back pain, randomized to either lumbar fusion or cognitive intervention and exercises.

Summary of Background Data.  In two clinical trials, patients with chronic low back pain plus disc degeneration and postlaminectomy syndrome, respectively, were randomized to either lumbar fusion or cognitive intervention and exercises. We have previously reported that results for the primary outcome were similar at the 1-year follow-up examination.

Methods.  As the treatment alternatives and test procedures were identical, the two trials were merged into one. A total of 124 patients 25 to 60 years of age were included. Muscle strength, measured by isokinetic test device and by the Biering-Sørensen Test, was measured in 112 patients, and the cross-sectional area and density of the back muscles were measured in 61 patients at the inclusion and at the 1-year follow-up examination.

Results.  The exercise group performed significantly better in muscle strength than did the lumbar fusion group, with the mean difference at 184 Nm (95% confidence interval, 64–303 Nm; P = 0.003) and for the Biering-Sørensen Test 21 seconds (95% confidence interval, 6–36 seconds; P = 0.006). The density at L3–L4 decreased in the lumbar fusion group but remained unchanged in the exercise group. The mean difference was 5.3 HU (95% confidence interval, 1.1–9.5 HU; P = 0.01). The cross-sectional area was unchanged in both groups.

Conclusions.  Patients with chronic low back pain who followed cognitive intervention and exercise programs improved significantly in muscle strength compared with patients who underwent lumbar fusion. In the lumbar fusion group, density decreased significantly at L3–L4 compared with the exercise group.

Muscle strength, cross-sectional area, and density of back muscles were investigated in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. At the 1-year follow-up examination, the exercise group performed significantly better in muscle strength than did the lumbar fusion group. Density decreased significantly at L3–L4 in the lumbar fusion group. The cross-sectional area remained unchanged. There were no correlations between muscle performance and morphology.

From the *Department of Physical Medicine and Rehabilitation, Ullevaal University Hospital; and the Departments of

†Orthopaedics and

‡Radiology, Rikshospitalet University Hospital, Oslo, Norway.

Acknowledgment date: October 24, 2002.

First revision date: January 20, 2003.

Acceptance date: April 28, 2003.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence to Anne Keller, MD, Department of Physical Medicine and Rehabilitation, Ullevaal University Hospital, N-0407 Oslo, Norway; e-mail: Anne.Keller@ioks.uio.no.

© 2004 Lippincott Williams & Wilkins, Inc.