Disabling chronic low-back pain is extremely prevalent in Western countries, entailing huge social costs; however, there are as yet no agreed management guidelines for this condition. A wide variety of treatments have been investigated in a large number of studies, with contradictory results. The problem is compounded by the fact that, owing to methodological biases, most of the studies performed are difficult to interpret.

Introduction

Disabling chronic low-back pain is extremely prevalent in Western countries, entailing huge social costs; however, there are as yet no agreed management guidelines for this condition. A wide variety of treatments have been investigated in a large number of studies, with contradictory results. The problem is compounded by the fact that, owing to methodological biases, most of the studies performed are difficult to interpret. Among the deficiencies encountered are extremely poor evaluation criteria, an overemphasis on the technical aspects of the treatments concerned, the absence of an assessor of sufficient scientific integrity, non-consecutive recruitment into the studies, inhomogeneous patient populations, failure to restrict each study to one disease entity, and consistent lack of a control group.

Nonsurgical treatments of whatever kind (drug treatment, physiotherapy, manual medicine) has been found to produce satisfactory results in only 25-65% of the cases. This is why at least one third of low-back pain sufferers will seek surgical treatment.

However, the results of surgery in patients with chronic low-back pain associated with disc disorders have been disappointingly uneven: regardless of the fusion technique employed, the rate of satisfactory results has...

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