Evidence for surgery in degenerative lumbar spine disorders

Best Pract Res Clin Rheumatol. 2013 Oct;27(5):673-84. doi: 10.1016/j.berh.2013.09.009. Epub 2013 Oct 5.


We aimed to evaluate the available evidence on the effectiveness of surgical interventions for a number of conditions resulting in low back pain (LBP) or spine-related irradiating leg pain. We searched the Cochrane databases and PubMed up to June 2013. We included systematic reviews and randomised controlled trials (RCTs) on degenerative disc disease (DDD), herniated disc, spondylolisthesis and spinal stenosis due to degenerative osteoarthritis. We included comparisons between surgery and conservative care and between different techniques. The quality of the systematic reviews was evaluated using assessment of multiple systematic reviews (AMSTAR). Twenty systematic reviews were included which covered the following diagnoses: disc herniation (n = 9), spondylolisthesis (n = 2), spinal stenosis (n = 3), DDD (n = 4) and combinations (n = 2). For most of the comparisons, no significant and/or clinically relevant differences between interventions were identified. In general, surgery is only indicated for relief of leg pain in clear indications such as disc herniation, spondylolisthesis or spinal stenosis.

Keywords: Low back pain; Lumbar disc herniation; Sciatica; Spinal stenosis; Spondylolisthesis; Surgery.

Publication types

  • Review

MeSH terms

  • Humans
  • Intervertebral Disc Degeneration / surgery*
  • Low Back Pain / surgery*
  • Lumbar Vertebrae*
  • Sciatica / surgery*
  • Spinal Stenosis / surgery*
  • Spondylolisthesis / surgery*
  • Treatment Outcome