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Review
. 2015 Mar 30;10(3):e0122800.
doi: 10.1371/journal.pone.0122800. eCollection 2015.

Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis

Gustavo C Machado  1 , Paulo H Ferreira  2 , Ian A Harris  3 , Marina B Pinheiro  2 , Bart W Koes  4 , Maurits van Tulder  5 , Magdalena Rzewuska  1 , Chris G Maher  1 , Manuela L Ferreira  6
Affiliations
Review

Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis

Gustavo C Machado et al. PLoS One. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow Diagram of Studies Included in the Systematic Review.
RCT = randomised controlled trial. *Number of citations includes duplicates.
Fig 2
Fig 2. Risk of Bias (PEDro) Criteria and Number of Trials in Each Category.
PEDro = Physiotherapy Evidence Database.
Fig 3
Fig 3. Mean Difference for Pain and Disability at Short-term Follow-up (less than 12 months).
*Decompression technique is laminectomy or laminotomy.
Fig 4
Fig 4. Mean Difference for Pain and Disability at Long-term Follow-up (12 months or more).
*Decompression technique is laminectomy or laminotomy
See this image and copyright information in PMC

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