In literature, several studies have reported that cognitive
behavioural therapy or intensive exercise programs have treatment
results similar to those of spinal fusion, but with considerably
less complications, morbidity and costs. As the findings
of the present thesis show that the currently used tests do
not improve the results of fusion by better patient selection,
these tests should not be recommended for surgical decision
making in standard care. Moreover, spinal fusion should not
be proposed as a standard treatment for chronic low back pain.
Causality of nonspecific spinal pain is complex and CLBP
should not be regarded as a diagnosis, but rather as a symptom
in patients with different stages of impairment and disability.
Patients should be evaluated in a multidisciplinary setting
or Spine Centre according to the so-called biopsychosocial
model, which aims to identify underlying psychosocial factors
as well as biological factors. Treatment should occur in a
stepwise fashion starting with the least invasive treatment. The
current approach of CLBP, in which emphasis is laid on selfmanagement
and empowerment of patients to take an active
course of treatment in order to prevent long-term disability
and chronicity, is recommended.