Surgery for Low Back Pain: A Review of the Evidence for an American Pain Society Clinical Practice Guideline

  title={Surgery for Low Back Pain: A Review of the Evidence for an American Pain Society Clinical Practice Guideline},
  author={Roger Chou and Jamie Baisden and Eugene J. Carragee and Daniel K Resnick and William O Shaffer and John D. Loeser},
Study Design. Systematic review. Objective. To systematically assess benefits and harms of surgery for nonradicular back pain with common degenerative changes, radiculopathy with herniated lumbar disc, and symptomatic spinal stenosis. Summary of Background Data. Although back surgery rates continue to increase, there is uncertainty or controversy about utility of back surgery for various conditions. Methods. Electronic database searches on Ovid MEDLINE and the Cochrane databases were conducted… 

Nonsurgical Interventional Therapies for Low Back Pain: A Review of the Evidence for an American Pain Society Clinical Practice Guideline

Good or fair evidence is found that chemonucleolysis is moderately superior to placebo injection but inferior to surgery, and fair evidence that epidural steroid injection is moderately effective for short-term symptom relief, for sciatica or prolapsed lumbar disc with radiculopathy.

Evidence for surgery in degenerative lumbar spine disorders.

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The body of literature supports fusion surgery as a viable treatment option for reducing pain and improving function in patients with chronic LBP refractory to nonsurgical care when a diagnosis of disc degeneration can be made.

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

The available evidence from systematic reviews on the effectiveness of surgical interventions for disc herniation, spondylolisthesis, stenosis, and degenerative disc disease (DDD) was quite acceptable, but the quality of the included studies was poor.

Nonoperative Treatment of Lumbar Spinal Stenosis With Neurogenic Claudication: A Systematic Review

Moderate- and high-GRADE evidence for nonoperative treatment is lacking and thus prohibiting recommendations to guide clinical practice, given the expected exponential rise in the prevalence of lumbar spinal stenosis with neurogenic claudication.

Radiofrequency denervation for chronic back pain: a systematic review and meta-analysis

RD of selected lumbosacral targets appears to have a small, short-term, positive effect for the management of patients with chronic back pain, but the quality of evidence for the majority of outcomes is low or very low quality and there is still a degree of uncertainty, particularly around the duration of effect.

Interventional Therapies, Surgery, and Interdisciplinary Rehabilitation for Low Back Pain: An Evidence-Based Clinical Practice Guideline From the American Pain Society

Due to important trade-offs between potential benefits, harms, costs, and burdens of alternative therapies, shared decision-making is an important component of a number of the recommendations.

Rehabilitation following surgery for lumbar spinal stenosis.

Whether active rehabilitation programmes following primary surgery for lumbar spinal stenosis have an impact on functional outcomes and whether such programmes are superior to 'usual postoperative care' is investigated.

Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis

There are indications that surgery is superior to physical activity-based interventions in reducing pain and disability for disc herniation at short-term follow-up only; but high-quality evidence in this field is lacking (GRADE).

Epidural injections in prevention of surgery for spinal pain: systematic review and meta-analysis of randomized controlled trials.




Systematic Review of Randomized Trials Comparing Lumbar Fusion Surgery to Nonoperative Care for Treatment of Chronic Back Pain

Surgery may be more efficacious than unstructured nonsurgical care for chronic back pain but may not be more efficient than structured cognitive-behavior therapy.

A Critical Review of Reviews on the Treatment of Chronic Low Back Pain

Although the overall quality of systematic reviews was satisfactory, the quality of the individual papers included in the reviews varied considerably and often provided contradictory evidence on the effectiveness of a wide range of commonly used conservative interventions for chronic nonspecific low back pain.

Surgery for Degenerative Lumbar Spondylosis: Updated Cochrane Review

No conclusions are possible about the relative effectiveness of anterior, posterior, or circumferential fusion, and the preliminary results of three small trials of intradiscal electrotherapy suggest it is ineffective, except possibly in highly selected patients.

Chronic Low Back Pain and Fusion: A Comparison of Three Surgical Techniques: A Prospective Multicenter Randomized Study From the Swedish Lumbar Spine Study Group

Three commonly used surgical techniques to achieve lumbar fusion primarily in terms of their ability to reduce pain and decrease disability in patients with severe chronic low back pain were compared.

Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials

The cumulative evidence at the present time does not support routine surgical fusion for the treatment of chronic low back pain, and surgery was found to be associated with a significant risk of complications.

Surgery for degenerative lumbar spondylosis.

Assessment of current scientific evidence on the effectiveness of surgical interventions for degenerative lumbar spondylosis found limited evidence is now available to support some aspects of surgical practice.

Outcome Measures for Low Back Pain Research: A Proposal for Standardized Use

An international group of back pain researchers considered recommendations for standardized measures in clinical outcomes research in patients with back pain and recommended a short, 6‐item questionnaire and a somewhat expanded, more precise battery of questionnaires, which would facilitate scientific advances in clinical care.

Efficacy of lumbar discectomy and percutaneous treatments for lumbar disc herniation

The benefits of open discectomy, principally reduced duration of pain, appear to justify its use in carefully selected patients when discogenic sciatica fails to improve with conservative measures.

Surgical Interventions for Lumbar Disc Prolapse: Updated Cochrane Review

Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear.

Total disc replacement for chronic low back pain: background and a systematic review of the literature

There is no evidence that disc replacement reliably, reproducibly, and over longer periods of time fulfils the three primary aims of clinical efficacy, continued motion, and few adjacent segment degenerative problems, and total disc replacements should be considered experimental procedures and should only be used in strict clinical trials.