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Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.

This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care. 

Advice

Spinal fusion surgery is not indicated as a treatment for chronic axial low back pain in most circumstances.

Evidence suggests there is no significant benefit to spinal fusion surgery to treat chronic axial low back pain except in certain circumstances.  Chronic pain is a symptom, not a diagnosis.

When is the procedure indicated?

Spinal fusion may be considered for managing chronic axial low back pain if it has been caused by trauma, cancer, infection or other pathology where there is painful deformity, instability or neural compression.

Best care recommendations

Treatment options for chronic axial low back pain include:

  • exercise
  • weight loss when indicated
  • education and self-management
  • psychological therapies (such as cognitive behaviour therapy) 
  • multidisciplinary biopsychosocial rehabilitation
  • pharmacological therapies (to allow active therapy) 
  • physiotherapy.

When spinal fusion is indicated, surgeons are encouraged to register the surgery on the Australian Spine Registry.
 

Evidence

Bydon M, De la Garza-Ramos R, Macki M, Baker A, Gokaslan AK, Bydon A. Lumbar fusion versus nonoperative management for treatment of discogenic low back pain: a systematic review and meta-analysis of randomized controlled trials. Journal of Spinal Disorders & Techniques. 2014;27(5):297-304.

Eck JC, Sharan A, Ghogawala Z, Resnick DK, Watters WC 3rd, Mummaneni PV, et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: Lumbar fusion for intractable low-back pain without stenosis or spondylolisthesis. Journal of Neurosurgery: Spine. 2014;21(1):42-7. 

Fritzell P, Hägg O, Wessberg P, Nordwall A; Swedish Lumbar Spine Study Group. 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine. 2001;26(23):2521-34. 

Malfliet A, Ickmans K, Huysmans E, Coppieters I, Willaert W, Van Bogaert W, et al. Best evidence rehabilitation for chronic pain. Part 3: Low back pain. Journal of Clinical Medicine. 2019 Jul;8(7):1063.

National Institute for Health Care Excellence. Low back pain ad sciatica in over 16s: assessment and management. London (UK): National Institute for Health Care Excellence; 2016. [cited 2020 Jun 13]. 

Page last updated: 23 Dec 2020

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