Surgery for degenerative lumbar spondylosis

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Surgical interventions for spinal conditions are common but often lack robust scientific evidence.
• Degenerative lumbar spondylosis encompasses various spinal conditions with significant healthcare costs.

Purpose of the Study:

• To systematically review the scientific evidence on the effectiveness of surgical interventions for degenerative lumbar spondylosis.
• To assess the quality of existing randomized controlled trials (RCTs) for surgical treatments of lumbar spondylosis.

Main Methods:

• Comprehensive literature search of multiple databases (CENTRAL, MEDLINE, PubMed, Spine) and expert correspondence.
• Inclusion of randomized or quasi-randomized trials of surgical treatments for lumbar spondylosis.
• Data extraction and quality assessment by two independent reviewers.

Main Results:

• Thirty-one RCTs were identified, with varying quality; recent trials showed improved methodology.
• Evidence for fusion surgery yielded conflicting results, with no clear benefit over physiotherapy or rehabilitation programs.
• Instrumented fusion did not consistently improve clinical outcomes and may increase complication rates; evidence for different fusion approaches and disc arthroplasty remains limited.

Conclusions:

• Current evidence supporting surgical interventions for degenerative lumbar spondylosis is limited.
• Further high-quality RCTs are essential to guide surgical practice and improve patient outcomes.
• Surgeons are encouraged to contribute to generating more robust evidence in this field.