Surgery versus conservative treatment for symptomatic XXXX : a systematic review of randomized controlled trials.

@entity1 @entity2649 @entity613 @entity158 @entity230
STUDY DESIGN: Systematic review. OBJECTIVE: To compare the effectiveness of surgery versus conservative treatment on @entity158 , disability, and loss of quality of life caused by symptomatic @entity2649 ( @entity2649 ). SUMMARY OF BACKGROUND DATA: @entity2649 is the most common reason for spine surgery in @entity1 older than 65 years in the United States. METHODS: Randomized controlled trials (RCTs) comparing any form of conservative and surgical treatment were searched in CENTRAL, MEDLINE, EMBASE, and TripDatabase databases until July 2009, with no language restrictions. Additional data were requested from the authors of the original studies. The methodological quality of each study was assessed independently by two reviewers, following the criteria recommended by the Cochrane Back Review Group. Only data from randomized cohorts were extracted. RESULTS: A total of 739 citations were reviewed. Eleven publications corresponding to five RCTs were included. All five scored as high quality despite concerns deriving from heterogeneity of treatment, lack of blinding, and potential differences in the size of the placebo effect across groups. They included a total of 918 @entity1 in whom conservative treatments had failed for 3 to 6 months, and included orthosis, rehabilitation, physical therapy, exercise, heat and cold, transcutaneous electrical nerve stimulation, ultrasounds, analgesics, nonsteroidal anti-inflammatory drugs, and epidural @entity230 . Surgical treatments included the implantation of a specific type of interspinous device and decompressive surgery (with and without fusion, instrumented or not). In all the studies, surgery showed better results for @entity158 , disability, and quality of life, although not for walking ability. Results of surgery were similar among @entity1 with and without spondylolisthesis, and slightly better among those with @entity613 than among those without it. The advantage of surgery was noticeable at 3 to 6 months and remained for up to 2 to 4 years, although at the end of that period differences tended to be smaller. CONCLUSION: In @entity1 with symptomatic @entity2649 , the implantation of a specific type of device or decompressive surgery, with or without fusion, is more effective than continued conservative treatment when the latter has failed for 3 to 6 months.
