PAIN+ CPN

Doctor, I have chronic low back pain. Should I treat it with total disc replacement surgery or multidisciplinary rehabilitation?


This study shows that both treatments may improve pain, function, and quality of life in the long term.


What is the evidence?


Researchers compared patients with low back pain who had a total disc replacement with patients with low back pain treated with multidisciplinary rehabilitation. They measured physical function, pain, and quality of life 8 years after the surgery or rehabilitation. They found that:


  • People in both groups had improved 8 years after completion of their treatment
  • People in the TDR group improved slightly more than people in the MDR group.
  • 21 of 87 people (24%) in the MDR group ended up having back surgery
  • 12 of 86 patients (14%) in the TDR group had to have more back surgery

What kind of study was this?

This was a randomised controlled trial (RCT). In an RCT, patients are randomly picked to go in one treatment group or the other treatment group.

Who participated in the study? This study included 173 patients in Norway who had low back pain for at least one year and had not improved with other treatments.

How was the study done? The studies compared participants who had total disc replacement surgery with patients who attended multidisciplinary rehabilitation program.  Participants were evaluated 8 years after their surgery or completion of their rehabilitation program.

Total disc replacement (86 patients)

vs

Multidisciplinary rehabilitation (87 patients)


Replacement of degenerative intervertebral lumbar disc with an artificial disc.

Patients were not referred for physiotherapy after their surgery, but they could be referred for exercises after 6 weeks on request.




60 hours of outpatient rehabilitation over 3-5 weeks. This consisted of lectures, discussions, and daily workouts to increase physical capacity, endurance, strength, and coordination.

Why was this research done?


Low back pain is very common. Lumbar total disc replacement had shown promising results in long term follow up, although it is controversial. Multidisciplinary rehabilitation had also shown good long-term results for patients. No studies had compared lumbar total disc replacement to multidisciplinary rehabilitation to see if one might be better than the other over a long period of time.


This Evidence Summary is based on the following article:

Furunes H, Storheim K, Brox JI, et al. Total disc replacement versus multidisciplinary rehabilitation in patients with chronic low back pain and degenerative discs: 8-year follow-up of a randomized controlled multicenter trial. Spine J. 2017 Oct;17(10):1480-1488. doi: 10.1016/j.spinee.2017.05.011. Epub 2017 Jun 2. PubMed

Published: Thursday, July 26, 2018