Meta-analysis Of Fusion With And Without Instrumentation In The Treatment Of Chronic Low Back Pain

ObjectiveTo evaluate the efficacy of fusion with and without instrumentation in the treatment of chronic low back pain.MethodsWe searched Medline(1 966 to December,2006),Embase(1 984 to December, 2006),Cochrane Central Register of Controlled Trial(4th Quarter 2006),Current Controlled Trials,The China Biological Medicine Database(1 984 to December, 2006),and hand searched several related journals.The quality of included trials was evaluated.Data were extracted by two reviewers independently with a desired extraction form.RevMan 4.2.8 software was used for data analysis.ResultsEight studies involving 656 patients were included.The results of meta-analysis indicated that statistically significant differences were observed between the two operative procedures in the fusion rate[OR 2.26,95%CI(1.51,3.38),P=0.0001], clinical outcome[OR 1.54,95%CI(1.09,2.19),P=0.01],incidence of re-operation[OR 2.16,95%CI(1.08,4.33),P=0.002].There are no statistically significant differences in Back pain scores[WMD-0.22,95%CI(-0.81,0.36)],leg pain scores[WMD 0.22, 95%CI(-0.50,0.93)],complications[OR 1.68,95%CI(0.78,3.63)],satisfaction of surgery by patients[OR 1.54,95%CI(0.93,2.55)].Three studies described the mean surgical time,perioperative blood loss,days in hospital after surgery,which revealed that single fusion was superior to fusion with instrumentation.Three studies described the work status of patients post-operatively.Two studies indicated smoking could decrease the fusion rate.ConclusionsTo compare with single fusion,fusion with instrumentation can increase the fusion rate and improve clinical outcome slightly,but it also increase the incidence of re-operation.More high quality large-scale randomized controlled trials are required.