Reviewer’s comment on “Five-year outcome of surgical decompression of the lumbar spine without fusion” by Mannion AF, Denzler R, Dvorak J, Grob D (doi:10.1007/s00586-010-1535-2)

Excerpt

This paper explored the long-term outcome of a cohort of patients undergoing decompression surgery who were recruited into an RCT exploring the use of post-operative physiotherapy. The earlier findings noted no differences between groups, so the groups were combined to determine the long-term outcome of the surgery at 5 years. Statistically, it may have been more eloquent to have used a regression model that included a term for the treatment groups which would identify that there were no differences between the original two groups after 5 years—the end result, however, may have been the same. Further, it is worth noting that the population presented in this paper may not be reflective of usual practice in many clinics as they were invited to participate in a trial evaluating types of post-operative physiotherapy and as such this may have attracted more pro-active patients interested in the intervention arms; indeed, an inclusion criterion was willingness to comply with the intervention and the absence of co-morbidities affecting active rehabilitation and a such may not be truly representative of the typical ageing population. …