Many people in the Western world experience chronic back pain that affects their quality of life and ability to work. Although researchers have been trying to find the best treatment for chronic back pain, study findings are conflicting about which is better: surgical or nonsurgical (conservative) treatment.

In this study, the authors searched through medical literature to find studies about surgery versus conservative treatment for non-specific back pain. They compared the different research methods used and study findings to see if they could decide on the best care for chronic lower back pain. They found four studies. The researchers then compared the studies for the types of surgery performed and the nonsurgical interventions, such as physiotherapy; information and education; pain relief methods; cognitive and functional training; rehabilitation; and supervised treatment. The success of the treatments was measured by how patients recovered from their back-specific disability, reported pain levels and general function, psychological function, if they returned to work, x-ray results, complications and, finally, how satisfied the patients were with their outcome.

Three of the four studies measured the rate of return to work. The researchers found that the rate of return wasn't consistent between them. In one study, more patients who had had surgery returned to work, in another, the numbers were just about equal between the surgery and the nonsurgery groups, and in the third, more patients who didn't have surgery returned to work.

Two studies used patient self-rating reports to measure success. In these two studies, patients who had surgery seemed to be more satisfied than those who didn't.

Two of the studies followed the patients for two years and the other two studies followed them for one year. In one 2-year study, patients who had surgery were much more satisfied than those who didn't, but in the other 2-year study, the number wasn't that much higher in the surgical group. In the 1-year studies, the results were the same: One study had a higher satisfaction rate with surgery, the other study didn't have such a difference.

The authors concluded that there were limitations to some of the studies that didn't allow the researchers to draw more definite conclusions about the treatments. While surgery did seem to have a modest advantage over nonsurgical treatment, it could be that it is the type of nonsurgical treatment that is more the issue.

Sohail K Mirza, MD, MPH, and Richard A. Deyo, MD, MPH. Systemic Review of Randomized Trials Comparing Lumbar Fusion Surgery to Nonoperative Care for Treatment of Chronic Back Pain. In Spine. April 2007. Vol. 32. No. 7. Pp. 816-823.