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Back Pain Research Review
Surgical Treatment
When assessing the results of surgical treatment, the importance of weighing the risks and benefits of intervention increases.
Low Back Pain
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Surgery for low back pain usually involves treating herniated discs in patients with sciatica, reducing pressure on painful nerve roots, or treating degenerative disc disease (which is a common age-related syndrome) where surgery is used to reduce pressure and/or stabilize vertebrae through fusion. Numerous surgical methods are used to treat herniated discs, eg, with or without the help of lasers or microscopes, or through minimally invasive surgery. There is no scientific evidence to show that these surgical methods would yield better results or fewer serious complications than conventional surgery (D).
The reviewed studies reveal many methodological deficiencies, mainly the studies on surgery for degenerative disc disorders aimed at measuring outcomes (which were often based on rough estimates by either the surgeons themselves or by patients who underwent surgery).
There is limited evidence on the outcome of surgery for herniated discs, but there is strong, indirect evidence on its effectiveness. The randomized studies that were reviewed showed herniated disc surgery to be more effective than chemonucleolysis (A), which, in turn, was shown to be more effective than placebo (A). Chemonucleolysis is an alternative to surgery and involves using the chymopapain enzyme to chemically dissolve the soft nucleus of the disc. The results of surgery are inferior when following failed chemonucleolysis.
Several surgical fusion methods are available to treat degenerative disc disorders or spinal stenosis, but there is no consensus on the definition and importance of spinal “instability”. No randomized controlled trials compare the effects of fusion with conventional treatment, placebo, or with the natural course of degenerative disc disease.
Neck Pain
The studies reviewed address the surgical treatment of chronic pain resulting from whiplash injuries, herniated discs, or spondylosis. Only one randomized controlled trial was found on surgery for spondylosis, with or without herniated disc involvement. This study reported no advantages from surgery . Regarding whiplash injuries, there is no evidence that surgery is superior to conservative treatment.
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