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Review: evidence supports surgery for lumbar disc prolapse but is insufficient for degenerative lumbar spondylosis

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 QUESTIONS: In patients with lumbar disc prolapse or degenerative lumbar spondylosis, is lumbar spine surgery effective, and which surgical techniques are most successful?

Data sources

Studies were identified by searching 6 databases, hand searching relevant surgical journals, scanning bibliographies of relevant articles, and contacting experts.

Study selection

Randomised controlled trials (RCTs) or quasi-randomised trials on the treatment of lumbar disc prolapse or degenerative lumbar spondylosis and the associated pathological findings or clinical syndromes of back pain, instability, spinal stenosis, and degenerative spondylolisthesis were included. Studies on spinal fractures, tumours, infection, childhood deformity, steroid injections, local anaesthetic, or particular postoperative regimens were excluded.

Data extraction

Data were extracted on methods, participants, interventions, and outcomes (treatment success, need for second procedure, and spinal fusion rates).

Main results

Lumbar disc prolapse:

26 RCTs met the selection criteria. The pooled results for 5 RCTs showed that …

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  • Source of funding: Medical Research Council, UK.

  • For correspondence: Mr JN Gibson, Princess Margaret Rose Orthopaedic Hospital, Edinburgh EH10 7ED, UK. Fax +44 (0)131 536 4754.

  • * Numbers calculated from data in article.

  • Gibson JN, Grant IC, Waddell G. Surgery for lumbar disc prolapse. Cochrane Review, latest version 24 Feb 1999. In: the Cochrane Library. Oxford: Update Software.