Thirty-one published RCTs of all forms of surgical treatment for degenerative lumbar spondylosis were included in a Cochrane review [Abstract] 1. The trials varied in quality: only the more recent trials used appropriate methods of randomization, blinding and independent assessment of outcome. When most of the earlier published results were of technical surgical outcomes, more of the recent trials also report patient-centered outcomes of pain or disability. There is still very little information on occupational outcomes or on long term outcomes beyond two to three years.
Seven heterogeneous trials on spondylolisthesis, spinal stenosis and nerve compression permitted limited conclusions. Two new trials on the effectiveness of fusion showed conflicting results. One showed that fusion gave better clinical outcomes than conventional physiotherapy, while the other showed that fusion was no better than a modern exercise and rehabilitation programme. Eight trials showed that instrumented fusion produced a higher fusion rate, but any improvement in clinical outcomes is probably marginal, while there is other evidence that it may be associated with higher complication rates. Three trials with conflicting results did not permit any conclusions about the relative effectiveness of anterior, posterior or circumferential fusion. Preliminary results of two small trials of intra-discal electrotherapy showed conflicting results. Preliminary data from three trials of disc arthroplasty did not permit any firm conclusions.
Primary/Secondary Keywords