Comparative Effectiveness Study for Surgery vs. Non-Surgery in Patients With Low Back Pain

NCT ID: NCT02883569

Last Updated: 2023-04-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1102 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-09-30

Study Completion Date

2021-12-31

Brief Summary

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Purpose: Comparative effectiveness research (CER) between surgical and non-surgical treatment for patients with low back pain Hypothesis: There will be significant differences in surgical and non-surgical treatment effect in patients who need operation for herniated intervertebral disc and spinal stenosis.

Detailed Description

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Background: Eighty percents of the total population experiences lower back pain (LBP). Prevalence of LBP is about 20 to 30%. LBP is the most frequent disease and causes a lot of the medical and social costs. Recently the traditional drug therapy, exercise therapy has been developed and various non-surgical treatments have been developed. Surgical techniques are also rapidly evolving. In Korea lumbar spine surgeries were performed in accordance with the national practice guidelines presented by the Health Insurance Review and Assessment Service. Many patients who do not meet the surgical criteria undergo the non-surgical treatment, but there is no reliable research data for a systematic and cost-effective results of non-surgical treatment. It will be a big part of the future medical expenses because there is no guideline for the expensive procedure.

Contents:

1. Prospective randomized controlled trials to evaluate effectiveness and efficacy between surgical vs. non-surgical treatment for optimal treatment of low back pain
2. Prospective observational clinical study for non-surgical treatment methods
3. Analysis of health insurance data
4. Comprehensive symposium
5. Provide guideline for optimal treatment of low back pain
6. The results will be used to reflect National health insurance policy Development Results: Suggestion of guideline for optimal treatment of low back pain through analysis of efficacy and effectiveness between treatments

Conditions

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Low Back Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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HIVD-OP

open or endoscopic discectomy

Group Type ACTIVE_COMPARATOR

open or endoscopic discectomy

Intervention Type PROCEDURE

FDA approved surgical procedures

decompression

Intervention Type PROCEDURE

FDA approved surgical procedure such as lamiectom and, laminotomy

instrumentation and fusion

Intervention Type PROCEDURE

FDA approved surgical procedure such as PLIF, ALIF, DLIF, OLI and TLIF

HIVD-NonOP

epidural block, epidural adhesiolysis, exercise, ibuprofen, naxoprofen, Cox-2 inhibitor, aceclofenac, codeine, oxycontine, IRcodone, Tramadol

Group Type EXPERIMENTAL

epidural block

Intervention Type PROCEDURE

epidural block

exercise

Intervention Type OTHER

educated exercise

ibuprofen, naxoprofen, Cox-2 inhibitor, aceclofenac

Intervention Type DRUG

FDA approved medication such as ibuprofen, naxoprofen etc.

codeine, oxycontine, IRcodone, Tramadol

Intervention Type DRUG

FDA approved opioid drug such as codeine, oxycontin, IRcodon

epidural adhesiolysis

Intervention Type PROCEDURE

FDA approved epidural adhesiolysis with catheter or endoscope

LSS w/o instability -OP

decompression, instrumentation and fusion

Group Type ACTIVE_COMPARATOR

decompression

Intervention Type PROCEDURE

FDA approved surgical procedure such as lamiectom and, laminotomy

instrumentation and fusion

Intervention Type PROCEDURE

FDA approved surgical procedure such as PLIF, ALIF, DLIF, OLI and TLIF

LSS w/o instability -NonOP

epidural block, epidural adhesiolysis, exercise, ibuprofen, naxoprofen, Cox-2 inhibitor, aceclofenac, codeine, oxycontine, IRcodone, Tramadol

Group Type EXPERIMENTAL

epidural block

Intervention Type PROCEDURE

epidural block

exercise

Intervention Type OTHER

educated exercise

ibuprofen, naxoprofen, Cox-2 inhibitor, aceclofenac

Intervention Type DRUG

FDA approved medication such as ibuprofen, naxoprofen etc.

codeine, oxycontine, IRcodone, Tramadol

Intervention Type DRUG

FDA approved opioid drug such as codeine, oxycontin, IRcodon

epidural adhesiolysis

Intervention Type PROCEDURE

FDA approved epidural adhesiolysis with catheter or endoscope

LSS w/ instability - OP

decompression, instrumentation and fusion

Group Type ACTIVE_COMPARATOR

decompression

Intervention Type PROCEDURE

FDA approved surgical procedure such as lamiectom and, laminotomy

instrumentation and fusion

Intervention Type PROCEDURE

FDA approved surgical procedure such as PLIF, ALIF, DLIF, OLI and TLIF

LSS w/ instability - NonOP

epidural block, epidural adhesiolysis, exercise, ibuprofen, naxoprofen, Cox-2 inhibitor, aceclofenac, codeine, oxycontine, IRcodone, Tramadol

Group Type EXPERIMENTAL

epidural block

Intervention Type PROCEDURE

epidural block

exercise

Intervention Type OTHER

educated exercise

ibuprofen, naxoprofen, Cox-2 inhibitor, aceclofenac

Intervention Type DRUG

FDA approved medication such as ibuprofen, naxoprofen etc.

codeine, oxycontine, IRcodone, Tramadol

Intervention Type DRUG

FDA approved opioid drug such as codeine, oxycontin, IRcodon

epidural adhesiolysis

Intervention Type PROCEDURE

FDA approved epidural adhesiolysis with catheter or endoscope

No intervention group

exercise, ibuprofen, naxoprofen, Cox-2 inhibitor, aceclofenac, codeine, oxycontine, IRcodone, Tramadol

Group Type ACTIVE_COMPARATOR

exercise

Intervention Type OTHER

educated exercise

ibuprofen, naxoprofen, Cox-2 inhibitor, aceclofenac

Intervention Type DRUG

FDA approved medication such as ibuprofen, naxoprofen etc.

codeine, oxycontine, IRcodone, Tramadol

Intervention Type DRUG

FDA approved opioid drug such as codeine, oxycontin, IRcodon

epidural adhesiolysis

Intervention Type PROCEDURE

FDA approved epidural adhesiolysis with catheter or endoscope

Intervention group

epidural block, epidural adhesiolysis

Group Type EXPERIMENTAL

epidural block

Intervention Type PROCEDURE

epidural block

Interventions

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open or endoscopic discectomy

FDA approved surgical procedures

Intervention Type PROCEDURE

epidural block

epidural block

Intervention Type PROCEDURE

exercise

educated exercise

Intervention Type OTHER

ibuprofen, naxoprofen, Cox-2 inhibitor, aceclofenac

FDA approved medication such as ibuprofen, naxoprofen etc.

Intervention Type DRUG

decompression

FDA approved surgical procedure such as lamiectom and, laminotomy

Intervention Type PROCEDURE

instrumentation and fusion

FDA approved surgical procedure such as PLIF, ALIF, DLIF, OLI and TLIF

Intervention Type PROCEDURE

codeine, oxycontine, IRcodone, Tramadol

FDA approved opioid drug such as codeine, oxycontin, IRcodon

Intervention Type DRUG

epidural adhesiolysis

FDA approved epidural adhesiolysis with catheter or endoscope

Intervention Type PROCEDURE

Other Intervention Names

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NSAID opioid

Eligibility Criteria

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Inclusion Criteria

1. Herniated intervertebral disease, Low back pain over 6 weeks: if neurological deficit is combined early surgery is allowed; Over 18 years; Visual analogue pain score over 5; Compatible findings in MRI and/or CT
2. Lumbar spinal stenosis without instability, Low back pain over 3 months: if neurological deficit is combined early surgery is allowed; Over 18 years; Visual analogue pain score over 5; Compatible findings in MRI and/or CT; Without instability (15 degrees and 4mm motion)
3. Lumbar spinal stenosis with instability, Low back pain over 3 months: if neurological deficit is combined early surgery is allowed; Over 18 years; Visual analogue pain score over 5; Compatible findings in MRI and/or CT; With instability (15 degrees and 4mm motion)
4. No surgical indication, Low back pain over 6 weeks: if neurological deficit is combined early surgery is allowed; Over 18 years; Visual analogue pain score over 5; Compatible findings in MRI and/or CT;

Exclusion Criteria

1. Herniated intervertebral disease, Cauda equine syndrome; Instability (15degrees, 4mm motion); Fracture, pregnancy; Any comorbidities that preclude operation; Combined disease: Neuromuscular disease, parkinson's disease, inflammatory arthritis, symptomatic spinal tumor, myelopathy, spinal infection; Previous lumbar spinal surgery; Neurological deficit that necessitates surgery
2. Lumbar spinal stenosis without instability, Cauda equine syndrome; Instability (15degrees, 4mm motion); Fracture, pregnancy Any comorbidities that preclude operation; Combined disease: Neuromuscular disease, parkinson's disease, inflammatory arthritis, symptomatic spinal tumor, myelopathy, spinal infection; Previous lumbar spinal surgery; Neurological deficit that necessitates surgery
3. Lumbar spinal stenosis with instability, Cauda equine syndrome; Fracture, pregnancy; Any comorbidities that preclude operation; Combined disease: Neuromuscular disease, parkinson's disease, inflammatory arthritis, symptomatic spinal tumor, myelopathy, spinal infection Previous lumbar spinal surgery; Neurological deficit that necessitates surgery
4. No surgical indication, Cauda equine syndrome; Fracture, pregnancy; Combined disease: Neuromuscular disease, parkinson's disease, inflammatory arthritis, symptomatic spinal tumor, myelopathy, spinal infection; Neurological deficit that necessitates surgery
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Seoul National University Bundang Hospital

OTHER

Sponsor Role collaborator

Gangnam Severance Hospital

OTHER

Sponsor Role collaborator

Severance Hospital

OTHER

Sponsor Role collaborator

Korea University Guro Hospital

OTHER

Sponsor Role collaborator

Seoul National University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Chun Kee Chung

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Chun Kee Chung, Professor

Role: PRINCIPAL_INVESTIGATOR

Seoul National University Hospital

Locations

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Seoul National University Hospital

Seoul, , South Korea

Site Status

Countries

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South Korea

Other Identifiers

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LBP

Identifier Type: -

Identifier Source: org_study_id

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