Arguments for the choice of surgical treatments in patients with lumbar spinal stenosis – a systematic appraisal of randomized controlled trials

BMC Musculoskeletal Disorders

Maria M Wertli²  Johann Steurer²  François Porchet¹  Jakob M Burgstaller² 

[1]Department of Neurosurgery, Spine Center, Schulthess Clinic, Zürich, Switzerland

[2]Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Pestalozzistrasse 24, Zurich, 8032, Switzerland

关键词: Low back pain;    Reoperation;    Instability;    Randomized controlled trial;    Systematic review;    Fecompression and fusion with instrumentation;    Decompression and fusion;    Decompression;    Surgery;    Lumbar spinal stenosis;   

Others  :  1174840
DOI  :  10.1186/s12891-015-0548-8

 received in 2014-11-20, accepted in 2015-04-01,  发布年份 2015

【 摘 要 】

Background

Lumbar spinal stenosis is the most common reason for spinal surgery in elderly patients. However, the surgical management of spinal stenosis is controversial. The aim of this review was to list aspects a surgeon considers when choosing a specific type of treatment.

Methods

Appraisal of arguments reported in randomized controlled trials (RCTs) included in systematic reviews published or indexed in the Cochrane library studying surgical treatments in patients with spinal stenosis.

Results

Eight out of nine RCTs listed arguments for the choice of their treatments under investigation. The argument for decompression alone was the high success rate, the argument against was a potential increase in vertebral instability. The argument for decompression and fusion without instrumentation was that it is a well-established technique with a high fusion success rate, the argument against it was that the indication for fusion in spinal stenosis has remained unclear. The argument for decompression and fusion with instrumentation was an increased fusion rate compared to decompression and fusion without instrumentation, the argument against this was that the invasive procedure is associated with more complications.

Conclusions

The main argument identified in this appraisal for and against decompression alone in patient with lumbar spinal stenosis was whether or not instability should be treated with (instrumented) fusion procedures. However, there is disagreement on how instability should be defined. In a first step it is important that researchers and clinicians agree on definitions for important key concepts such as instability and reoperations.

【 授权许可】

   
2015 Burgstaller et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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