Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis
The management of spinal stenosis by surgery has increased rapidly in the past two decades, however, there is still controversy regarding the efficacy of surgery for this condition. Our aim was to investigate the efficacy and comparative effectiveness of surgery in the management of patients with lu...
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| Veröffentlicht in: | PloS one 2015-03, Vol.10 (3), p.e0122800-e0122800 |
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| creator | Machado, Gustavo C Ferreira, Paulo H Harris, Ian A Pinheiro, Marina B Koes, Bart W van Tulder, Maurits Rzewuska, Magdalena Maher, Chris G Ferreira, Manuela L |
| description | The management of spinal stenosis by surgery has increased rapidly in the past two decades, however, there is still controversy regarding the efficacy of surgery for this condition. Our aim was to investigate the efficacy and comparative effectiveness of surgery in the management of patients with lumbar spinal stenosis.
Electronic searches were performed on MEDLINE, EMBASE, AMED, CINAHL, Web of Science, LILACS and Cochrane Library from inception to November 2014. Hand searches were conducted on included articles and relevant reviews. We included randomised controlled trials evaluating surgery compared to no treatment, placebo/sham, or to another surgical technique in patients with lumbar spinal stenosis. Primary outcome measures were pain, disability, recovery and quality of life. The PEDro scale was used for risk of bias assessment. Data were pooled with a random-effects model, and the GRADE approach was used to summarise conclusions.
Nineteen published reports (17 trials) were included. No trials were identified comparing surgery to no treatment or placebo/sham. Pooling revealed that decompression plus fusion is not superior to decompression alone for pain (mean difference -3.7, 95% confidence interval -15.6 to 8.1), disability (mean difference 9.8, 95% confidence interval -9.4 to 28.9), or walking ability (risk ratio 0.9, 95% confidence interval 0.4 to 1.9). Interspinous process spacer devices are slightly more effective than decompression plus fusion for disability (mean difference 5.7, 95% confidence interval 1.3 to 10.0), but they resulted in significantly higher reoperation rates when compared to decompression alone (28% v 7%, P < 0.001). There are no differences in the effectiveness between other surgical techniques for our main outcomes.
The relative efficacy of various surgical options for treatment of spinal stenosis remains uncertain. Decompression plus fusion is not more effective than decompression alone. Interspinous process spacer devices result in higher reoperation rates than bony decompression. |
| doi_str_mv | 10.1371/journal.pone.0122800 |
| format | Article |
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Electronic searches were performed on MEDLINE, EMBASE, AMED, CINAHL, Web of Science, LILACS and Cochrane Library from inception to November 2014. Hand searches were conducted on included articles and relevant reviews. We included randomised controlled trials evaluating surgery compared to no treatment, placebo/sham, or to another surgical technique in patients with lumbar spinal stenosis. Primary outcome measures were pain, disability, recovery and quality of life. The PEDro scale was used for risk of bias assessment. Data were pooled with a random-effects model, and the GRADE approach was used to summarise conclusions.
Nineteen published reports (17 trials) were included. No trials were identified comparing surgery to no treatment or placebo/sham. Pooling revealed that decompression plus fusion is not superior to decompression alone for pain (mean difference -3.7, 95% confidence interval -15.6 to 8.1), disability (mean difference 9.8, 95% confidence interval -9.4 to 28.9), or walking ability (risk ratio 0.9, 95% confidence interval 0.4 to 1.9). Interspinous process spacer devices are slightly more effective than decompression plus fusion for disability (mean difference 5.7, 95% confidence interval 1.3 to 10.0), but they resulted in significantly higher reoperation rates when compared to decompression alone (28% v 7%, P < 0.001). There are no differences in the effectiveness between other surgical techniques for our main outcomes.
The relative efficacy of various surgical options for treatment of spinal stenosis remains uncertain. Decompression plus fusion is not more effective than decompression alone. Interspinous process spacer devices result in higher reoperation rates than bony decompression.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0122800</identifier><identifier>PMID: 25822730</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Clinical trials ; Confidence intervals ; Decompression ; Effectiveness ; Health sciences ; Humans ; Lumbar Vertebrae - surgery ; Medical schools ; Meta-analysis ; Pain ; Patients ; Quality of life ; Reoperation ; Searching ; Spinal stenosis ; Spinal Stenosis - surgery ; Studies ; Surgery ; Surgical outcomes ; Surgical techniques ; Systematic review ; Treatment Outcome</subject><ispartof>PloS one, 2015-03, Vol.10 (3), p.e0122800-e0122800</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Machado et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Machado et al 2015 Machado et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-73fe1df0a6cf5a1f75d46bcd0ea393283d02cefd713facbdd44a7483cde478143</citedby><cites>FETCH-LOGICAL-c758t-73fe1df0a6cf5a1f75d46bcd0ea393283d02cefd713facbdd44a7483cde478143</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378944/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378944/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25822730$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Machado, Gustavo C</creatorcontrib><creatorcontrib>Ferreira, Paulo H</creatorcontrib><creatorcontrib>Harris, Ian A</creatorcontrib><creatorcontrib>Pinheiro, Marina B</creatorcontrib><creatorcontrib>Koes, Bart W</creatorcontrib><creatorcontrib>van Tulder, Maurits</creatorcontrib><creatorcontrib>Rzewuska, Magdalena</creatorcontrib><creatorcontrib>Maher, Chris G</creatorcontrib><creatorcontrib>Ferreira, Manuela L</creatorcontrib><title>Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The management of spinal stenosis by surgery has increased rapidly in the past two decades, however, there is still controversy regarding the efficacy of surgery for this condition. Our aim was to investigate the efficacy and comparative effectiveness of surgery in the management of patients with lumbar spinal stenosis.
Electronic searches were performed on MEDLINE, EMBASE, AMED, CINAHL, Web of Science, LILACS and Cochrane Library from inception to November 2014. Hand searches were conducted on included articles and relevant reviews. We included randomised controlled trials evaluating surgery compared to no treatment, placebo/sham, or to another surgical technique in patients with lumbar spinal stenosis. Primary outcome measures were pain, disability, recovery and quality of life. The PEDro scale was used for risk of bias assessment. Data were pooled with a random-effects model, and the GRADE approach was used to summarise conclusions.
Nineteen published reports (17 trials) were included. No trials were identified comparing surgery to no treatment or placebo/sham. Pooling revealed that decompression plus fusion is not superior to decompression alone for pain (mean difference -3.7, 95% confidence interval -15.6 to 8.1), disability (mean difference 9.8, 95% confidence interval -9.4 to 28.9), or walking ability (risk ratio 0.9, 95% confidence interval 0.4 to 1.9). Interspinous process spacer devices are slightly more effective than decompression plus fusion for disability (mean difference 5.7, 95% confidence interval 1.3 to 10.0), but they resulted in significantly higher reoperation rates when compared to decompression alone (28% v 7%, P < 0.001). There are no differences in the effectiveness between other surgical techniques for our main outcomes.
The relative efficacy of various surgical options for treatment of spinal stenosis remains uncertain. Decompression plus fusion is not more effective than decompression alone. Interspinous process spacer devices result in higher reoperation rates than bony decompression.</description><subject>Analysis</subject><subject>Clinical trials</subject><subject>Confidence intervals</subject><subject>Decompression</subject><subject>Effectiveness</subject><subject>Health sciences</subject><subject>Humans</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Medical schools</subject><subject>Meta-analysis</subject><subject>Pain</subject><subject>Patients</subject><subject>Quality of life</subject><subject>Reoperation</subject><subject>Searching</subject><subject>Spinal stenosis</subject><subject>Spinal Stenosis - surgery</subject><subject>Studies</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Surgical techniques</subject><subject>Systematic review</subject><subject>Treatment Outcome</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk1tv0zAUxyMEYmPwDRBYQkLw0OJLEjs8IE3TgEqTJnF74MVy7ePWUxIXOyn02-O02dSgPSA_-PY7_3OxT5Y9J3hOGCfvbnwfWlXPN76FOSaUCowfZKekYnRWUsweHq1Psicx3mBcMFGWj7MTWghKOcOn2c9La0F3bgstxIi8RbEPKwg7ZH1Add8sVUBx45InFDtofXTxPVIo7tKuUZ3TKMDWwW-kWoMa6NRMJXaXsKfZI6vqCM_G-Sz7_vHy28Xn2dX1p8XF-dVM80J0M84sEGOxKrUtFLG8MHm51AaDYil-wQymGqzhhFmll8bkueK5YNpAzgXJ2Vn28qC7qX2UY1miJGXJy5QnH4jFgTBe3chNcI0KO-mVk_sDH1ZShZRKDbKiRBNmjGAW55RVoiJgWVrislhaM2h9GL31ywaMhrYLqp6ITm9at5Yrv5U546LKB4E3o0Dwv3qInWxc1FDXqgXf7-MWlKXgWUJf_YPen91IrVRKwLXWJ796EJXnOakwK9ne7fweKg0DjdPpD1mXzicGbycGiengT7dSfYxy8fXL_7PXP6bs6yN2Daru1tHXfed8G6dgfgB18DEGsHdFJlgOLXBbDTm0gBxbIJm9OH6gO6PbP8_-Au-DAa8</recordid><startdate>20150330</startdate><enddate>20150330</enddate><creator>Machado, Gustavo C</creator><creator>Ferreira, Paulo H</creator><creator>Harris, Ian A</creator><creator>Pinheiro, Marina B</creator><creator>Koes, Bart W</creator><creator>van Tulder, Maurits</creator><creator>Rzewuska, Magdalena</creator><creator>Maher, Chris G</creator><creator>Ferreira, Manuela L</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20150330</creationdate><title>Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis</title><author>Machado, Gustavo C ; Ferreira, Paulo H ; Harris, Ian A ; Pinheiro, Marina B ; Koes, Bart W ; van Tulder, Maurits ; Rzewuska, Magdalena ; Maher, Chris G ; Ferreira, Manuela L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c758t-73fe1df0a6cf5a1f75d46bcd0ea393283d02cefd713facbdd44a7483cde478143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Analysis</topic><topic>Clinical trials</topic><topic>Confidence intervals</topic><topic>Decompression</topic><topic>Effectiveness</topic><topic>Health sciences</topic><topic>Humans</topic><topic>Lumbar Vertebrae - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Machado, Gustavo C</au><au>Ferreira, Paulo H</au><au>Harris, Ian A</au><au>Pinheiro, Marina B</au><au>Koes, Bart W</au><au>van Tulder, Maurits</au><au>Rzewuska, Magdalena</au><au>Maher, Chris G</au><au>Ferreira, Manuela L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-03-30</date><risdate>2015</risdate><volume>10</volume><issue>3</issue><spage>e0122800</spage><epage>e0122800</epage><pages>e0122800-e0122800</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The management of spinal stenosis by surgery has increased rapidly in the past two decades, however, there is still controversy regarding the efficacy of surgery for this condition. Our aim was to investigate the efficacy and comparative effectiveness of surgery in the management of patients with lumbar spinal stenosis.
Electronic searches were performed on MEDLINE, EMBASE, AMED, CINAHL, Web of Science, LILACS and Cochrane Library from inception to November 2014. Hand searches were conducted on included articles and relevant reviews. We included randomised controlled trials evaluating surgery compared to no treatment, placebo/sham, or to another surgical technique in patients with lumbar spinal stenosis. Primary outcome measures were pain, disability, recovery and quality of life. The PEDro scale was used for risk of bias assessment. Data were pooled with a random-effects model, and the GRADE approach was used to summarise conclusions.
Nineteen published reports (17 trials) were included. No trials were identified comparing surgery to no treatment or placebo/sham. Pooling revealed that decompression plus fusion is not superior to decompression alone for pain (mean difference -3.7, 95% confidence interval -15.6 to 8.1), disability (mean difference 9.8, 95% confidence interval -9.4 to 28.9), or walking ability (risk ratio 0.9, 95% confidence interval 0.4 to 1.9). Interspinous process spacer devices are slightly more effective than decompression plus fusion for disability (mean difference 5.7, 95% confidence interval 1.3 to 10.0), but they resulted in significantly higher reoperation rates when compared to decompression alone (28% v 7%, P < 0.001). There are no differences in the effectiveness between other surgical techniques for our main outcomes.
The relative efficacy of various surgical options for treatment of spinal stenosis remains uncertain. Decompression plus fusion is not more effective than decompression alone. Interspinous process spacer devices result in higher reoperation rates than bony decompression.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25822730</pmid><doi>10.1371/journal.pone.0122800</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Analysis Clinical trials Confidence intervals Decompression Effectiveness Health sciences Humans Lumbar Vertebrae - surgery Medical schools Meta-analysis Pain Patients Quality of life Reoperation Searching Spinal stenosis Spinal Stenosis - surgery Studies Surgery Surgical outcomes Surgical techniques Systematic review Treatment Outcome |
| title | Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis |
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