Aim People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from non-surgical treatments. However, NICE (UK) guidelines recommended not offering surgery for adults with LBP except within a randomised clinical trial (RCT). This survey aims to describe UK clinicians’ views regarding equipoise for randomisation of participants in a future RCT comparing lumbar spine fusion surgery to best conservative care (the FORENSIC-UK trial). Method An online cross-sectional survey was shared with clinical professional groups in the UK involved in the management of adults with severe, persistent LBP. The survey had 7 sections covering the respondents' demographics, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future RCTs. Results There were 73 respondents (potential response rate of 9.13%) comprising 39 orthopaedic spine surgeons, 17 neurosurgeons, 2 pain specialists and 15 allied health professionals (AHPs). Most (84.7%) chose conservative care as their first-choice management for all five case vignettes. Over 50% reported willingness to randomise three of the five cases to either surgery or best conservative care (BCC), indicating equipoise facilitating the future RCT. Transforaminal interbody fusion was the preferred approach for spinal fusion (36.4%) and for BCC, combined program of physical and psychological therapy (48.5%). Conclusions This survey evidence that there is equipoise about the role of lumbar spine fusion surgery and BCC for a range of patients with persistent LBP.
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Bada et al. (2024) studied this question.
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