Does fusion lead to increased adjacent level disc degeneration in patients with chronic low back pain. An international collaborate project.

There is controversy as to whether fusion of one or more motion segments of the spine results in accelerated degeneration of the adjacent segment over time. Some argue that adjacent segment is exposed to increased mechanical stress, which accelerates disc degeneration, whilst others maintain that disc degeneration (ALDD) is genetically driven, and would occur in the given segment regardless of fusion. Published studies cannot answer this dispute. Four randomised controlled trials (RCT) including 767 pati ents have been conducted in Europe to compare 1-2 year outcome of patients treated operatively and non-operatively for chronic low back pain. The aim of the present study is to assess as many of these patients as possible using x-ray and MRI (for disc deg enration), blod sampling (for DNA analyses) and standard outcome questionnaires (for pain and disability) in order to examine the main research question. This prsents an unique opportunity to assess outcome with regrads to disc degenerative changes at 8-1 0 years follow-up. This is a cross-sectional study for assessment of current disc degeneration status. Validated outcome measures will be used and assessed by independent radiologists. We expect to produce at least two high-quality papers in peer-review ed journals. The second part of the study is a long-term follow up of the two Norwegian studies. At one-year follow up we reported that there were no difference between spinal fusion and cognitive intervention and exercises in the main outcome (disablity ), but that fear-avoidance beliefs, finger-tip to floor-distance and muscle strength was improved after cognitive intervention and exercises, only. The short-term benefit in terms of psychological factors and muscle fuction may have long term consequences for disability, use of health care resources, and quality of life. Contrary, recurrences may indicate surgery. The long term frequency of spinal surgery in the two groups is an important research question.