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Surgery for degenerative lumbar spondylosis
J N Gibson1, G Waddell, I C Grant
1Clinical Research Unit, Princess Margaret Rose, Orthopaedic Hospital, Edinburgh EH10 7ED, UK. J.N.A.Gibson@ed.ac.uk
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Surgical interventions for degenerative lumbar spondylosis lack evidence of effectiveness. Current research shows no trials comparing surgery to conservative treatments, and instrumented fusion offers no clinical benefit over non-instrumented fusion.
Area of Science:
- Spinal Surgery
- Orthopedics
- Evidence-Based Medicine
Background:
- Degenerative lumbar spondylosis encompasses conditions like lumbar spondylosis and degenerative disc disease, causing back pain, instability, spinal stenosis, and spondylolisthesis.
- Surgical interventions are often considered for these debilitating conditions.
Purpose of the Study:
- To systematically review the evidence on the effectiveness of surgical interventions for degenerative lumbar spondylosis.
- To assess the impact of various surgical techniques on patient outcomes.
Main Methods:
- A comprehensive search of multiple databases including Cochrane, Medline, Embase, and Biosis was conducted.
- Randomized or quasi-randomized trials of surgical treatments for lumbar spondylosis were selected.
- Trial quality was assessed, and data were extracted by two independent reviewers.
Main Results:
- Fourteen trials were identified, but many suffered from significant design flaws, including poor randomization and lack of blinding, leading to potential bias.
- No trials compared surgical interventions against natural history, placebo, or conservative treatments.
- While instrumented fusion showed higher fusion rates, it did not improve clinical outcomes and may increase complication rates.
Conclusions:
- There is a lack of scientific evidence to support the effectiveness of any surgical decompression or fusion for degenerative lumbar spondylosis.
- The current evidence base is insufficient to guide surgical decision-making for these conditions.