Trial reportSpine2003
Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration.
Trial report in Spine, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 140 papers, 18 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Physical Capability Outcomes After Single-Level ProDisc-L Total Disc Replacement or Single-Level Anterior Lumbar Interbody Fusion: a Multi-Center Clinical Trial
sPinal coRd stimulatiOn coMpared With Lumbar InStrumEntation for Low Back Pain After Previous Lumbar Decompression (PROMISE): a Prospective Randomized Controlled Study
The Lumbar Interbody Fusion vs. Multidisciplinary Rehabilitation (LIFEHAB) Trial
Who cites it
140 citing papers in PubMed, 18 syntheses or guidelines pooled it, 620 citations in OpenAlex.
- Interventions to enhance work participation in people with chronic pain: A systematic review and meta-analysis including analysis of complex psychological intervention components.British journal of health psychology · 2026Pooled it
- Comparison between spinal fusion vs. nonoperative treatment for lumbar degenerative pathology: a systematic review and meta-analysis.Neurosurgical review · 2025Pooled it
- Evaluation of Cognitive Behavioral Therapy on Improving Pain, Fear Avoidance, and Self-Efficacy in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis.Pain research & management · 2022Pooled it
- Motor control exercise for acute non-specific low back pain.The Cochrane database of systematic reviews · 2016Pooled it
- Motor control exercise for chronic non-specific low-back pain.The Cochrane database of systematic reviews · 2016Pooled it
- Multidisciplinary biopsychosocial rehabilitation for chronic low back pain.The Cochrane database of systematic reviews · 2014Pooled it
- Rehabilitation following surgery for lumbar spinal stenosis.The Cochrane database of systematic reviews · 2013Pooled it
- Systematic review of active workplace interventions to reduce sickness absence.Occupational medicine (Oxford, England) · 2013Pooled it
- Psychological therapies for the management of chronic pain (excluding headache) in adults.The Cochrane database of systematic reviews · 2012Pooled it
- Low back pain (chronic).BMJ clinical evidence · 2010Pooled it
- Behavioural treatment for chronic low-back pain.The Cochrane database of systematic reviews · 2010Pooled it
- [Can failed back surgery be prevented? Psychological risk factors for postoperative pain after back surgery].Der Orthopade · 2008Pooled it
- Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials.International orthopaedics · 2008Pooled it
- A systematic review of measures used to assess chronic musculoskeletal pain in clinical and randomized controlled clinical trials.The journal of pain · 2007Pooled it
- Health economic evaluation in lumbar spinal fusion: a systematic literature review anno 2005.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2006Pooled it
- Methodological aspects of outcomes research.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2006Pooled it
- Surgery for degenerative lumbar spondylosis.The Cochrane database of systematic reviews · 2005Pooled it
- Evidence-informed management of chronic low back pain with cognitive behavioral therapy.The spine journal : official journal of the North American Spine SocietyPooled it
- Efficacy of a Tumor Necrosis Factor Inhibitor in Chronic Low-Back Pain With Modic Type 1 Changes: A Randomized Controlled Trial.Arthritis & rheumatology (Hoboken, N.J.) · 2025Trial
- Trial
80 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by[Operations].2012
Authors and funding
12 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
designSingle blind randomized study.
objectivesTo compare the effectiveness of lumbar instrumented fusion with cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. SUMMARY OF BACKGROUND DATA: To the authors' best knowledge, only one randomized study has evaluated the effectiveness of lumbar fusion. The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician. PATIENTS AND
methodsSixty-four patients aged 25-60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4-L5 and/or L5-S1 at radiographic examination were randomized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy, or cognitive intervention and exercises. The cognitive intervention consisted of a lecture to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The main outcome measure was the Oswestry Disability Index.
resultsAt the 1-year follow-up visit, 97% of the patients, including 6 patients who had either not attended treatment or changed groups, were examined. The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery, compared with 42 to 30 after cognitive intervention and exercises. The mean difference between groups was 2.3 (-6.7 to 11.4) (P = 0.33). Improvements inback pain, use of analgesics, emotional distress, life satisfaction, and return to work were not different. Fear-avoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment, and lower limb pain was reduced more after surgery. The success rate according to an independent observer was 70% after surgery and 76% after cognitive intervention and exercises. The early complication rate in the surgical group was 18%.
conclusionThe main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration randomized to cognitive intervention and exercises, or lumbar fusion.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.