The Evidence on Surgical Interventions for Low Back Pain, An Overview of Systematic Reviews (pp. 23-42)
Authors: (Wilco C.H. Jacobs, Paul C.P.H. Willems, Department of Neurosurgery, Leiden University Medical Center, The Netherlands, and others)
Abstract: Chapter structure: Overview of systematic reviews. Goal: To identify and evaluate available evidence from systematic literature reviews on the effectiveness of surgical interventions for low back pain. Background: Evidence on the effectiveness of treatments for low back pain is growing as research methods pertaining to literature reviews are improving and gaining in popularity. Methodology and results: Discussed are Cochrane reviews supplemented with adequate quality non-Cochrane systematic literature reviews published in peer reviewed journals. Spinal stenosis, disc herniation, spondylolisthesis, and degenerative disc disease are included. Comparisons used in the reviews are conservative treatment versus surgical treatment and comparisons between different surgical techniques. The quality of available evidence is evaluated in a methodological sense and shortcomings of the current evidence are discussed. No meta-analysis is anticipated, the results are presented descriptively. Discussion: There is evidence in the current literature on the effectiveness of treatment strategies for specific low back pain, but there are areas that are not covered, such as surgical technique for nonspecific low back pain or degenerative lumbar disc disease. Innovative interventions are frequently studied, but rarely compared to a gold standard. Some comparisons could only be made indirectly and an overview of the evidence is lacking. In addition, the quality of evidence can be improved in several aspects: The search needs to be rigorous, a quality assessment of included studies is essential, and analysis needs to be reflected against a clinically relevant outcome. The agenda for completion and restructure of evidence on low back pain is discussed.