MRC Spine Stabilisation Trial

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

Fairbank J, Frost H, Wilson-MacDonald J, et al. BMJ (Clinical research ed.) 2005 · PMID 15911537 · doi:10.1136/bmj.38441.620417.8f

Question

Is spinal fusion more effective than an intensive rehabilitation programme for chronic low back pain?

Design

Pragmatic multicentre RCT in 15 UK secondary care orthopaedic and rehabilitation centres.

Patients

Adults aged 18-55 with at least 1 year of chronic low back pain considered candidates for spinal fusion.

Intervention

Surgical stabilisation (spinal fusion)

Comparison

Intensive rehabilitation programme combining exercise and cognitive behavioural principles

Primary outcome

Oswestry Disability Index and shuttle walking test at 2 years

Key result

Fusion produced only a small difference in Oswestry score of borderline significance, with no meaningful advantage in walking, while carrying surgical risk and greater cost.

Limitations

Almost a fifth of participants were lost to follow-up; the rehabilitation programme was resource-intensive and may not be widely available.

Impact on practice

Underpins NICE NG59 advice not to offer spinal fusion for non-specific low back pain outside a randomised trial.