Lumbar spine fusion surgery versus best conservative care for patients with severe, persistent low back pain.

Autor:	Bada ES; The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK., Gardner AC; The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.; Aston University, Birmingham, UK., Ahuja S; Cardiff and Vale University Health Board, Cardiff, UK., Beard DJ; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford, UK.; RCSEng Surgical Intervention Trials Unit, Oxford, UK.; University of Oxford, Oxford, UK., Window P; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Queensland, Australia.; Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia., Foster NE; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Queensland, Australia.; Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia., Beard DJ; University of Oxford, NDORMS, Oxford, UK., Ahuja S; Cardiff and Vale University Health Board, Cardiff, UK., Davies L; University of Oxford, NDORMS, Oxford, UK., Foster N; The University of Queensland, Queensland, Australia., Cole A; Sheffield Children's NHS Foundation Trust, Sheffield, UK., Blackburn S; Keele University, Keele, UK., Greenwood J; University College London Hospitals NHS Foundation Trust, London, UK., Khan A; Leeds General Infirmary, Leeds, UK., Donovan J; University of Bristol, Bristol, UK., Wade J; University of Bristol, Bristol, UK., Price C; Solent NHS Trust, Southampton, UK., Gardner A; The Royal Orthopaedic Hospital NHS Foundation Trust, Brimingham, UK., Anjarwalla N; Frimley Health NHS Foundation Trust, Camberley, United Kingdom., Jowett S; University of Birmingham, Birmingham, UK., Reddington M; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK., Rombach I; University of Oxford, NDORMS, Oxford, UK.; University of Sheffield, Sheffield, UK., Tatton S
Jazyk:	angličtina
Zdroj:	Bone & joint open [Bone Jt Open] 2024 Jul 19; Vol. 5 (7), pp. 612-620. Date of Electronic Publication: 2024 Jul 19.
DOI:	10.1302/2633-1462.57.BJO-2023-0147.R1
Abstrakt:	Aims: People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians' views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial). Methods: An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials. Results: There were 72 respondents, with a response rate of 9.0%. They comprised 39 orthopaedic spine surgeons, 17 neurosurgeons, one pain specialist, and 15 allied health professionals. Most respondents (n = 61,84.7%) chose conservative care as their first-choice management option for all five case vignettes. Over 50% of respondents reported willingness to randomize three of the five cases to either surgery or BCC, indicating a willingness to participate in the future randomized trial. From the respondents, transforaminal interbody fusion was the preferred approach for spinal fusion (n = 19, 36.4%), and the preferred method of BCC was a combined programme of physical and psychological therapy (n = 35, 48.5%). Conclusion: This survey demonstrates that there is uncertainty about the role of lumbar spine fusion surgery and BCC for a range of example patients with severe, persistent LBP in the UK. Competing Interests: S. Ahuja reports funding from the NIHR/HTA, and reimbursement for attending Spine ODEP/BC meetings from NHS Supply Chain Coordinated Ltd, unrelated to this study. D. J. Beard is Co-Chief Investigator for FORENSIC-UK (grant number: NIHR134859), and holds a NIHR Senior Investigator grant, unrelated to this study. A. C. Gardner reports funding from NIHR HTA, ORUK, and Innovate UK, unrelated to this study, and is the research lead for the British Scoliosis Society. P. Window reports Royal Brisbane and Women’s Foundation Grants (2021, 2022, and 2024), and a THRIVE Allied Health Professional Grant 2023, unrelated to this study. (© 2024 Bada et al.)
Databáze:	MEDLINE
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