Quality assessment of systematic reviews for surgical treatment of low back pain: an overview

Abstract Background Context Low back pain is among the most frequent causes for medical appointments. Surgical treatment is widely controversial and new surgical techniques and treatment modalities have been developed within the last decade. Treatment for Low Back Pain should be evidence-based through Systematic Reviews and Meta Analysis. Thus, the quality of these reviews is sometimes put into question since methodological mistakes are frequently seen. Purpose The aim of this study is to gather all Systematic Reviews for the surgical treatment of Low Back Pain and analyze their outcomes, quality and conclusion. Study Design/Setting An overview of Systematic Reviews Outcome Measures AMSTAR score, PRISMA statement, conclusion supported by descriptive statistics. Methods A literature search for Systematic Reviews containing Low Back Pain surgical treatment was conducted through different medical databases. Two investigators independently assessed all titles and abstracts for inclusion. Studies should have at least one surgical procedure as an intervention. Diagnoses were categorized as lumbar disc herniation, spondylolisthesis, stenosis, facet joint syndrome, and degenerative disc disease. Quality was assessed through the PRISMA and AMSTAR questionnaires. Study quality related to its PRISMA and/or AMSTAR score percentage was rated as: very poor (90%). Articles were considered conclusive if they had a conclusion for their primary outcome supported by descriptive statistical evidence. This study was funded exclusively by the authors' own resources. None of the authors have any potential conflict of interest to declare. Results Overall, there were 40 systematic reviews included. According to AMSTAR and PRISMA scores, 5-7.5% of the Systematic Reviews were rated as excellent and most of them were rated as a fair review. AMSTAR indicated that 22.5% of the reviews have very poor quality, while PRISMA stated 7.5% being of very poor quality. For both tools, performing a Meta Analysis made the reviews' quality significantly better. The best-rated diagnosis groups according to PRISMA were Spondylosis, Lumbar Disc Herniation and Degenerative Disc Disease. Considering the studies' conclusions, 25 (62.5%) out of the 40 Systematic Reviews had a conclusion to their primary outcome and only 11 (27.5%) were supported by descriptive statistical analysis. This means that 44% of the Systematic Reviews with a con