Background: Low back pain is a common medical problem in general population with high morbidity and healthcare costs. The optimal management strategy, including the role of surgical intervention, remains controversial. We conducted a randomized prospective cohort study to compare the efficacy of surgery and conservative management for chronic low back pain.

Materials and Methods: This randomized prospective cohort study was conducted on 130 patients with low back pain. Patients were divided randomly into Group I (Conservative management) and Group II (surgical management). Follow up of patients was done at intervals of 1 week, 4 weeks, 3 months and then 6 month, 1 year and 2 years. Visual Analog Scale (VAS) was used for assessment of pain for all patients. Modified Mc Nab Scale was used as post operative/management tool to assess intensity of low back pain and quality of life.

Results: There was a gradual decline in VAS score for Group 1 till follow up whereas an early and sharp decrease in VAS scorewas seen for Group II till 3 months after which it increased on an average till last follow up. Mac Nab scale showed gradual improvement in condition of patients over a period of time for Group I with more patients showing improvement by 1 year. Mc Nab scale showed good results starting within first week only up to 3 months for Group II. Later there was some deterioration/static scores in group 2 perticularly, and patients were almost in same state at 2 years of follow up for both the groups.

Conclusion: A gradual improvement in condition occurs by conservative management for chronic low back pain. Surgical management provides immediate good results but in  some patients pain relief may not last for long period. More studies comparing the two treatment options can give better insight into the selection of treatment option for the patients with chronic low back pain and may validate our results.

Keywords: Conservative management, Low back pain, surgical management, Visual Analog Scale, Modified Mac Nab criteria.

1. Ping Chung Leung. The use of conservative and alternative therapy for low back pain. Medicines 2015; 2: 287-297. doi:10.3390/medicines2030287
2. Ibrahim, IM Tleyjeh and O. Gabbar. Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials.International Orthopaedics (SICOT) 2008;32:107–113. DOI 10.1007/s00264-006-0269-6.
3. Willems P. Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion. Acta Orthop Suppl. 2013 Feb;84(349):1-35. doi: 10.3109/17453674.2012.753565.
4. Bredow J, Bloess K, Oppermann J, Boese CK, Löhrer L, Eysel P.Conservative treatment of nonspecific, chronic low back pain : Evidence of the efficacy - a systematic literature review. 2016 Jul;45(7):573-8. doi: 10.1007/s00132-016-3248-7.
5. Christensen FB and Bünger C. Stabilisation surgery for chronic low back pain: indications, surgical procedures, and outcome. Scand J Rheumatol 2004;33: 210–217.
6. Deyo RA, Gray DT, Krueter W, Mirza S, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions. Spine 2005;30:1441–1445.
7. Keller A, Brox JI, Gunderson R, Holm I, Friis A, Reikerås O. Trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine 2003;29:3–8.
8. Ekman P, Möller H, Hedlund R. The long-term effect of posterolateral fusion in adult isthmic spondylolisthesis: a randomized controlled study. Spine J 2005;5:36–44
9. Fairbank J, Frost H, Wilson-MacDonald J, et al. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ. 2005;330:1233–9.
10. Brox JI, Sorensen R, Friis A, et al. Randomized Clinical trial of lumbar instrumented fusion and cognitive intervention and exercise in patients with chronic low back pain and disc degeneration. Spine. 2003;28:1913–21.
11. Chopko B, Liu JC, Khan MK. Anatomic surgical management of chronic low back pain. 2014 Oct;17 Suppl 2:46-51. doi: 10.1111/ner.12169.
12. Anne F Mannion, Federico Balagué, Ferran Pellisé & Christine Cedraschi. Pain measurement in patients with low back pain. Nature Clinical Practice Rheumatology 2007;3: 610–618. doi:10.1038/ncprheum0646.
13. K. Mirza et al.One-year outcomes of surgical versus nonsurgical treatments for discogenic back pain: a community-based prospective cohort study. The Spine Journal 2013.
14. Richard A Deyo, Sohail K Mirza, Patrick J Heagerty, Judith A Turner and Brook I Martin. A prospective cohort study of surgical treatment for back pain with degenerated discs; study protocol.BMC Musculoskeletal Disorders 2005, 6:24.

Dr Mamta Harjai

MBBS, MD, Associate Professor, Department of Anaesthesia, Dr. RMLIMS, Lucknow, UP India