One popular catchphrase that is often aimed at doctors in general, and at consultants in particular, is: 'If you have a hammer, everything looks like a nail'. In practice, this means that an oncologist will recommend chemotherapy or radiation, and a surgeon will want to operate - because that's all they can do.
This is equally the case with back specialists, many of whom still favour spinal fusion for chronic low back pain. It's one of the wonders of modern medicine that specialists persist with a procedure that's been discredited by a range of studies.
A knock-out blow was delivered by the Cochrane review five years ago, which concluded after a meta-analysis of earlier trials that there was little merit in the procedure. It's a view that has been echoed by studies ever since.
Now researchers from the Nuffield Orthopaedic Centre in Oxford have discovered that fusion surgery offers no benefits over rehabilitation. In other words gentle exercise is just as good as surgery, but without all the pain and inconvenience.
The researchers tracked 349 patients with chronic low back pain, 176 of whom had surgery, and 173 had rehabilitation instead. The rehabilitation programme included tailored daily exercises, including stretching, muscle strengthening, and aerobic exercises such as treadmill walking, step-ups, cycling and rowing. Virtually every participant in rehabilitation had hydrotherapy treatment every day, and most had cognitive behaviour therapy, which helped them overcome fears and beliefs that many patients develop when in pain.
After two years both groups reported similar levels of improvement, making it difficult to justify the cost, risks and inconvenience of surgery.
Still, if you have a hammer. . .