The MRC Spine Stabilization Trial: Surgical Methods, Outcomes, Costs, and Complications of Surgical Stabilization

Wilson-MacDonald, James; Fairbank, Jeremy; Frost, Helen; Yu, Ly-Mee; Barker, Karen; Collins, Rory; Campbell, Helen

Abstract

STUDY DESIGN:
A review of the surgical costs and results in a group of patients randomly allocated to surgery as part of a large prospective randomized trial of patients with chronic back pain.
OBJECTIVE:
To report the observational data from the surgical arm of a randomized trial comparing surgery with intensive rehabilitation for chronic low back pain. Clinical and economic data are reported.
SUMMARY OF BACKGROUND DATA:
Surgery for chronic low back pain is a well established but unproven intervention. The most cost-effective technique for spinal stabilization is still not established.
METHODS:
One hundred six patients with chronic low back pain were randomized to the surgical group of a randomized trial comparing spinal fusion of the lumbar with a 3 week intensive rehabilitation program. The primary outcomes were the Oswestry Disability Index (ODI) and the Shuttle Walking Test measured at baseline and 2 years postrandomization. Patients were stratified by preoperative diagnosis, smoking habit, and litigation. Complications were assessed and costs analyzed.
RESULTS:
Of the 176 surgical patients, 56 underwent postero-lateral fusion, 57 underwent interbody fusion, and 24 underwent flexible stabilization of the spine. The mean ODI for all patients in the surgical arm of the trial improved from a baseline of 46.5 (SD 14.6) to 34.2 (SD 21) at 2 years. Health care costs were higher ( 3109 pounds difference) for more complex procedures, and nearly 6 times as many early complications occurred with the more complex procedures. Smoking and unemployment were associated with worse results whereas litigation did not adversely affect the outcome.
CONCLUSION:
These observational changes in the ODI after surgery are similar to those reported from other studies of spinal fusion. More complex surgery is more expensive with more complications than postero-lateral fusion.

Citation

Wilson-MacDonald, J., Fairbank, J., Frost, H., Yu, L.-M., Barker, K., Collins, R., & Campbell, H. (2008). The MRC Spine Stabilization Trial: Surgical Methods, Outcomes, Costs, and Complications of Surgical Stabilization. Spine, 33(21), 2334-2340. https://doi.org/10.1097/brs.0b013e318186a8b2

• Journal Article Type: Article
• Publication Date: 2008-10
• Deposit Date: Oct 17, 2017
• Journal: Spine
• Print ISSN: 0362-2436
• Electronic ISSN: 1528-1159
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 33
• Issue: 21
• Pages: 2334-2340
• DOI: https://doi.org/10.1097/brs.0b013e318186a8b2
• Keywords: Orthopedics and Sports Medicine; Clinical Neurology
• Public URL: http://researchrepository.napier.ac.uk/Output/998465