Article Text

Review: evidence for the effectiveness of surgery for low back pain, radiculopathy, and spinal stenosis is limited

Statistics from


Is surgery effective for low back pain, radiculopathy, and symptomatic spinal stenosis?

Review scope

Included studies evaluated surgery as treatment for non-radicular low back pain with common degenerative changes, radiculopathy with herniated lumbar disc, or symptomatic spinal stenosis in patients >18 years of age who had low back pain. Studies reported ⩾1 of the following outcomes: back-specific function, general health status, pain, work disability, and patient satisfaction. Exclusion criteria included pregnancy and low back pain associated with acute major trauma, cancer, infection, cauda equina syndrome, osteoporosis, and vertebral compression fracture.

Review methods

Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (all to Jul 2008) and reference lists were searched for randomised controlled trials (RCTs) published in English or included in English-language systematic reviews, and English-language systematic reviews published after 1999. Experts were contacted. 74 RCTs, including 62 reported in 22 systematic reviews, met the inclusion criteria: 20 RCTs (n = 2669) involved non-radicular back pain with common degenerative changes; 35 {n = 4732}* involved radiculopathy with herniated lumbar disc; and 19 {n = 1994}* involved spinal stenosis with or without degenerative spondylolisthesis.

Main results

The main results are in the table.

Selected surgical interventions for low back pain, radiculopathy, or spinal stenosis*


Discectomy is better than non-surgical therapy for short-term but not long-term relief of radiculopathy. Evidence for the effectiveness of other types of surgery is limited.

*Information provided by author.

Abstract and commentary also appear in ACP Journal Club.

Abstracted from

Chou R, Baisden J, Carragee EJ, et al. Surgery for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine 2009;34:1094–109.

Clinical Impact Ratings: GP/FP/Primary care 6/7; Neurology 6/7; Anaesthesiology 6/7; Physical medicine and rehabilitation 6/7; Rheumatology 6/7; Surgery – Orthopaedics 5/7; Surgery – Neurosurgery 5/7

View Abstract


  • Source of funding: American Pain Society.

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