nach oben

Erschienen in:

01.09.2013 | Review Article

The evidence on surgical interventions for low back disorders, an overview of systematic reviews

verfasst von: Wilco C. H. Jacobs, Sidney M. Rubinstein, Paul C. Willems, Wouter A. Moojen, Ferran Pellisé, Cumhur F. Oner, Wilco C. Peul, Maurits W. van Tulder

Erschienen in: European Spine Journal | Ausgabe 9/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Many systematic reviews have been published on surgical interventions for low back disorders. The objective of this overview was to evaluate the available evidence from systematic reviews on the effectiveness of surgical interventions for disc herniation, spondylolisthesis, stenosis, and degenerative disc disease (DDD). An earlier version of this review was published in 2006 and since then, many new, better quality reviews have been published.

Methods

A comprehensive search was performed in the Cochrane database of systematic reviews (CDSR), database of reviews of effectiveness (DARE) and Pubmed. Two reviewers independently performed the selection of studies, risk of bias assessment, and data extraction. Included are Cochrane reviews and non-Cochrane systematic reviews published in peer-reviewed journals. The following conditions were included: disc herniation, spondylolisthesis, and DDD with or without spinal stenosis. The following comparisons were evaluated: (1) surgery vs. conservative care, and (2) different surgical techniques compared to one another. The methodological quality of the systematic reviews was evaluated using AMSTAR. We report (pooled) analyses from the individual reviews.

Results

Thirteen systematic reviews on surgical interventions for low back disorders were included for disc herniation (n = 6), spondylolisthesis (n = 2), spinal stenosis (n = 4), and DDD (n = 4). Nine (69 %) were of high quality. Five reviews provided a meta-analysis of which two showed a significant difference. For the treatment of spinal stenosis, intervertebral process devices showed more favorable results compared to conservative treatment on the Zurich Claudication Questionnaire [mean difference (MD) 23.2 95 % CI 18.5–27.8]. For degenerative spondylolisthesis, fusion showed more favorable results compared to decompression for a mixed aggregation of clinical outcome measures (RR 1.40 95 % CI 1.04–1.89) and fusion rate favored instrumented fusion over non-instrumented fusion (RR 1.37 95 % CI 1.07–1.75).

Conclusions

For most of the comparisons, the included reviews were not significant and/or clinically relevant differences between interventions were identified. Although the quality of the reviews was quite acceptable, the quality of the included studies was poor. Future studies are likely to influence our assessment of these interventions.

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G (2006) Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15(Suppl 2):S192–S300PubMedCrossRef

Anderson PA, Tribus CB, Kitchel SH (2006) Treatment of neurogenic claudication by interspinous decompression: application of the X STOP device in patients with lumbar degenerative spondylolisthesis. J Neurosurg Spine 4(6):463–471PubMedCrossRef

Andersson GBJ, Mekhail NA, Block JE (2006) Treatment of intractable discogenic low back pain. A systematic review of spinal fusion and intradiscal electrothermal therapy (IDET). Pain Physician 9(3):237–248PubMed

Bastian H, Glasziou P, Chalmers I (2010) Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? PLoS Med 7(9):e1000326PubMedCrossRef

Bhandari M, Tornetta P, Ellis T, Audige L, Sprague S, Kuo JC, Swiontkowski MF (2004) Hierarchy of evidence: differences in results between non-randomized studies and randomized trials in patients with femoral neck fractures. Arch Orthop Trauma Surg 124(1):10–16PubMedCrossRef

Carragee EJ, Hurwitz EL, Weiner BK (2011) A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned. Spine J 11(6):471–491PubMedCrossRef

Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD (2009) Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976) 34(10):1094–1109CrossRef

Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, Castel LD, Kalsbeek WD, Carey TS (2009) The rising prevalence of chronic low back pain. Arch Intern Med 169(3):251–258PubMedCrossRef

Freeman BJ (2006) IDET: a critical appraisal of the evidence. Eur Spine J 15(Suppl 3):S448–S457PubMedCrossRef

10.

Furlan AD, Pennick V, Bombardier C, van Tulder M (2009) 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976) 34(18):1929–1941CrossRef

11.

Furlan AD, Tomlinson G, Jadad AA, Bombardier C (2008) Examining heterogeneity in meta-analysis: comparing results of randomized trials and nonrandomized studies of interventions for low back pain. Spine (Phila Pa 1976) 33(3):339–348CrossRef

12.

Gibson J, Waddell G (2005) Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev (4):CD001352

13.

Gibson JNA, Waddell G (2007) Surgical interventions for lumbar disc prolapse. Cochrane Database Syst Rev (2):CD001350

14.

Hestbaek L, Leboeuf-Yde C, Manniche C (2003) Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 12(2):149–165PubMed

15.

Hirsch JA, Singh V, Falco FJ, Benyamin RM, Manchikanti L (2009) Automated percutaneous lumbar discectomy for the contained herniated lumbar disc: a systematic assessment of evidence. Pain Physician 12(3):601–620PubMed

16.

Ioannidis JP, Haidich AB, Pappa M, Pantazis N, Kokori SI, Tektonidou MG, Contopoulos-Ioannidis DG, Lau J (2001) Comparison of evidence of treatment effects in randomized and nonrandomized studies. JAMA 286(7):821–830PubMedCrossRef

17.

Jacobs WC, van Tulder M, Arts M, Rubinstein SM, van Middelkoop M, Ostelo R, Verhagen A, Koes B, Peul WC (2011) Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J 20(4):513–522PubMedCrossRef

18.

Jacobs WC, Vreeling A, de Kleuver M (2006) Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J 15(4):391–402PubMedCrossRef

19.

Kabir SM, Gupta SR, Casey AT (2010) Lumbar interspinous spacers: a systematic review of clinical and biomechanical evidence. Spine (Phila Pa 1976) 35(25):E1499–E1506CrossRef

20.

Kovacs FM, Urrutia G, Alarcon JD (2011) Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine (Phila Pa 1976) 36(20):E1335–E1351CrossRef

21.

Kuijpers T, van Middelkoop M, Rubinstein SM, Ostelo R, Verhagen A, Koes BW, van Tulder MW (2011) A systematic review on the effectiveness of pharmacological interventions for chronic non-specific low-back pain. Eur Spine J 20(1):40–50PubMedCrossRef

22.

Lambeek LC, van Tulder MW, Swinkels IC, Koppes LL, Anema JR, van Mechelen W (2011) The trend in total cost of back pain in The Netherlands in the period 2002 to 2007. Spine (Phila Pa 1976) 36(13):1050–1058CrossRef

23.

Lewis R, Williams N, Matar H, Din N, Fitzsimmons D, Phillips C, Jones M, Sutton A, Burton K, Nafees S, Hendry M, Rickard I, Chakraverty R, Wilkinson C (2011) The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model. Health Technol Assess 15(39):1–578PubMed

24.

Martin CR, Gruszczynski AT, Braunsfurth HA, Fallatah SM, O’Neil J, Wai EK (2007) The surgical management of degenerative lumbar spondylolisthesis: a systematic review. Spine (Phila Pa 1976) 32(16):1791–1798CrossRef

25.

McGirt MJ, Ambrossi GL, Datoo G, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Bydon A (2009) Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery 64(2):338–344PubMedCrossRef

26.

Mirza SK, Deyo RA (2007) Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain. Spine (Phila Pa 1976) 32(7):816–823CrossRef

27.

Moller H, Hedlund R (2000) Surgery versus conservative management in adult isthmic spondylolisthesis—a prospective randomized study: part 1. Spine (Phila Pa 1976) 25(13):1711–1715CrossRef

28.

Moojen WA, Arts MP, Bartels RH, Jacobs WC, Peul WC (2011) Effectiveness of interspinous implant surgery in patients with intermittent neurogenic claudication: a systematic review and meta-analysis. Eur Spine J 20(10):1596–1606PubMedCrossRef

29.

Nellensteijn J, Ostelo R, Bartels R, Peul W, van Royen B, van Tulder M (2010) Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature. Eur Spine J 19(2):181–204PubMedCrossRef

30.

Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 33(1):90–94CrossRef

31.

Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW (2007) Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 356(22):2245–2256PubMedCrossRef

32.

Postacchini F, Cinotti G, Perugia D, Gumina S (1993) The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. J Bone Joint Surg Br 75(3):386–392PubMed

33.

Pratt RK, Fairbank JC, Virr A (2002) The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 27(1):84–91CrossRef

34.

Revel M, Payan C, Vallee C, Laredo JD, Lassale B, Roux C, Carter H, Salomon C, Delmas E, Roucoules J (1993) Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica. A randomized multicenter trial. Spine (Phila Pa 1976) 18(1):1–7CrossRef

35.

Savigny P, Kuntze S, Watson P, Underwood M, Ritchie G, Cotterell M, Hill D, Buchanan E, Coffey P, Dixon P, Drummond C, Flanagan M, Greenough C, Griffiths M, Halliday-Bell J, Hettinga D, Vogel S, Walsh D (2009) NICE clinical guideline 88 low back pain: early management of persistent non-specific low back pain. National Collaborating Centre for Primary Care and Royal College of General Practitioners, London

36.

Shah RV, Albert TJ, Bruegel-Sanchez V, Vaccaro AR, Hilibrand AS, Grauer JN (2005) Industry support and correlation to study outcome for papers published in Spine. Spine (Phila Pa 1976) 30(9):1099–1104CrossRef

37.

Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7:10PubMedCrossRef

38.

Shojania KG, Bero LA (2001) Taking advantage of the explosion of systematic reviews: an efficient MEDLINE search strategy. Eff Clin Pract 4(4):157–162PubMed

39.

Transfeldt EE, Mehbod AA (2007) Evidence-based medicine analysis of isthmic spondylolisthesis treatment including reduction versus fusion in situ for high-grade slips. Spine (Phila Pa 1976) 32(19 Suppl):S126–S129CrossRef

40.

US National library of medicine Pubmed clinical queries filter (2011) 1 June 2011. http://www.ncbi.nlm.nih.gov/pubmed/clinical

41.

van den Eerenbeemt KD, Ostelo RW, van Royen BJ, Peul WC, van Tulder MW (2010) Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature. Eur Spine J 19(8):1262–1280 [1432-0932 (Electronic), 0940-6719 (Linking)]PubMedCrossRef

42.

van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW (2011) A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 20(1):19–39PubMedCrossRef

43.

van Tulder MW, Koes B, Seitsalo S, Malmivaara A (2006) Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review. Eur Spine J 15(Suppl 1):S82–S92PubMedCrossRef

44.

Walker BF (2000) The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 13(3):205–217PubMedCrossRef

45.

Watters WC III, Bono CM, Gilbert TJ, Kreiner DS, Mazanec DJ, Shaffer WO, Baisden J, Easa JE, Fernand R, Ghiselli G, Heggeness MH, Mendel RC, O’Neill C, Reitman CA, Resnick DK, Summers JT, Timmons RB, Toton JF (2009) An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J 9(7):609–614PubMedCrossRef

46.

Watters WC III, McGirt MJ (2009) An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J 9(3):240–257PubMedCrossRef

47.

Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom B, Skinner JS, Abdu WA, Hilibrand AS, Boden SD, Deyo RA (2006) Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA 296(20):2441–2450PubMedCrossRef

48.

Yajun W, Yue Z, Xiuxin H, Cui C (2010) A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease. Eur Spine J 19(8):1250–1261 [1432-0932 (Electronic), 0940-6719 (Linking)]PubMedCrossRef

49.

Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, Johnson DR, Skidmore GA, Vessa PP, Dwyer JW, Puccio S, Cauthen JC, Ozuna RM (2004) A prospective randomized multi-center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1-year results. Eur Spine J 13(1):22–31PubMedCrossRef

Titel: The evidence on surgical interventions for low back disorders, an overview of systematic reviews
verfasst von: Wilco C. H. Jacobs
Sidney M. Rubinstein
Paul C. Willems
Wouter A. Moojen
Ferran Pellisé
Cumhur F. Oner
Wilco C. Peul
Maurits W. van Tulder
Publikationsdatum: 01.09.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 9/2013
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-013-2823-4

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

The evidence on surgical interventions for low back disorders, an overview of systematic reviews