EVALUATION OF THE EFFICACY, SAFETY, EFFECTIVENESS AND EFFICIENCY
OF SURGERY IN THE TREATMENT OF LUMBAR SPINAL STENOSIS
Title.
Effectiveness of surgery in comparison with
conservative treatment in symptomatic spinal stenosis: a systematic
review of the scientific literature.
Background.
Lumbar spinal stenosis consists of the narrowing,
at the level of the lumbar vertebral spine, of the canal in
which the spinal medulla is located. When this narrowing comes
to compress nerves, it tends to cause symptoms and signs.
The most typical scene is the "intermittent psuedoclaudication"
also known as "neurogenic claudication" or "non-vascular
claudication". In it, a pain appears that is manifested
only on walking and only in the leg or legs (and not in the
low back area). Once the pain appears, it becomes more intense
as the patient continues walking, finally obliging the patient
to stop and sit down. The pain disappears in that position
(usually in a matter of seconds or minutes), but it reappears
when the patient starts walking again.
Initially, lumbar spinal stenosis tends to be treated with
conservative procedures such as medications or exercise, but
in the cases in which that treatment fails, surgery is considered.
The clinical perception is that surgery is effective and in
fact is indicated and is carried out commonly in the Spanish
National Health System. However, at present, a survey of the
scientific evidence that determines the basis for that perception
is lacking.
Objective.
To detect and analyze the existing scientific
literature on the effectiveness of surgery in comparison with
conservative treatment for symptomatic lumbar spinal stenosis
and summarize it in a solid recommendation.
Methodology.
It was a systematic review and meta-analysis
of the scientific literature. All of the clinical trials comparing
the efficacy or effectiveness of surgery with conservative
treatment for symptomatic lumbar stenosis were identified.
To find those studies, electronic search strategies were
used, as well as additional strategies to identify the potential
studies that had not been collected in those bases.
The methodological quality of each one of the studies found
was studied, and a sensitivity analysis was conducted to explore
the possible relation between quality and the results of each
study. The evaluation of the scientific quality of each study
included aspects of methodological quality (such as those
relating to the design of the clinical trial, in accordance
with the established standards of the international scientific
community), and clinical or technical quality (related to
the surgical techniques and the procedures for conservative
treatment used in each trial).
The scientific quality of each study was appraised by two
independent reviewers in order to guarantee greater rigor
in their appraisals. In the cases where they disagreed, a
joint discussion was held and a final consensus was reached,
with the contribution of the rest of the researchers in those
cases where needed.
The characteristics of all the identified clinical trials
were described structurally and an overall appraisal of the
effect of each electrotherapy technique was made by means
of the OR (odds ratio) or when the studied effects were very
frequent, using the RR (relative risk), calculated by means
of the Revman or Stata programs. Both the absolute measures
of the effect as well as the necessary number of patients
to treat in order to observe the desired effect (NNT) were
calculated.
Participants, along with the Foundation's
Science Department.
Cochrane IberoAmerican Center and the Department
of Rheumatology Rehabilitation at the Hospital Ramón
y Cajal.
The study was co-funded by the Funds for Health Research (FIS)
and the Kovacs Foundation.
Status.
In progress.
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