Tests Don't Predict Outcome After Spine Fusion for Back Pain

Current tests don't have prognostic accuracy for selection of patients with chronic low back pain

THURSDAY, Nov. 15 (HealthDay News) -- Currently, there is no test available to reliably predict which patients with chronic low back pain (LBP) will achieve a good clinical outcome after spinal fusion surgery, according to the results of a literature review published online Nov. 5 in The Spine Journal.

Paul C. Willems, M.D., Ph.D., of the Maastricht University Medical Center in the Netherlands, and colleagues conducted a systematic review of the literature and identified 10 studies to examine the prognostic accuracy of tests to predict which patients with chronic LBP will benefit from spinal fusion surgery.

The researchers found that none of the tests (immobilization by orthosis, provocative discography, and temporary external fixation) demonstrated clinically useful prognostic accuracy. No studies on the utility of magnetic resonance imaging or facet joint blocks met the inclusion criteria. Conclusions were hampered by obscure patient selection, high risk of verification bias, and use of poorly validated instruments for outcome assessment.

"No subset of patients with chronic LBP could be identified for whom spinal fusion is a predictable and effective treatment," the authors write. "Best evidence does not support the use of current tests for patient selection in clinical practice."

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