INTRODUCTION: The MRC sponsored Spine Stabilisation Trial (SST) was a landmark study of 349 patients with chronic low back pain considered candidates for spinal fusion surgery. It suggested that intensive rehabilitation can produce similar results to spinal fusion at 2 years at about half the cost. However there remained a need to ascertain the longer term outcome of patients managed by the rehabilitation and the surgical strategies
METHODS: At 2 years there were 329 subjects remaining in the SST. These subjects were followed for a further 5 years. Subjects were contacted by postal questionnaire and completed the Oswestry Disability Index (primary outcome), SF‐ 36 and Euroqol‐5 questionnaire. They also completed a question about whether they had received either surgery or rehabilitation since completion of the original trial intervention that they were allocated. An intention to treat ANCOVA analysis was carried out.
RESULTS: At the 7 year follow up 235 (67%) subjects completed the ODI (109 rehab and 126 surgery groups). There was a non significant difference of 2.29 (CI ‐7.9 – 3.2) between the groups in favour of rehabilitation (rehabilitation mean ODI 32.7 (std error 2.03, 95% CI 28.7‐36.7); surgery mean ODI 35 (std error 1.98, 95% CI 31.1‐38.9). There were no statistically significant differences in the outcomes for the two intervention strategies for SF‐36 and Euroqol. Overall there were only small changes in ODI values between the 2 and 7 year follow up.
DISCUSSION: This research suggests that rehabilitation including a cognitive behavioural approach is as beneficial as surgery in the longer term (7 years after randomisation). Whilst subjects in both groups remained moderately disabled, rehabilitation was less invasive and cheaper. It is impossible to rule out the possibility that subjects would have improved without either intervention, but rehabilitation should be seriously considered prior to fusion surgery.