An evidence-based review of the current surgical treatments for chronic low-back pain: rationale, indications, and novel therapies.

Abstract

Objective: This review analyzes the current surgical strategies and management modalities for chronic low-back pain (CLBP). In this study, the authors provide a structured review of the current state of surgical treatments for CLBP, including the rationale for surgery, indications, and novel therapies.

Methods: An extensive review of the literature on the surgical management of CLBP was performed using the MEDLINE, Cochrane, Google Scholar, Embase, and Cochrane Central Register of Controlled Trials databases from March 1993 to May 2024. Terms used in the search were ("low back pain/surgery" [MeSH] AND "chronic" AND "lumbar") and ("chronic" AND "low back pain" AND "lumbar spine" AND "surgery"). The search produced 1951 articles, of which 167 were removed as duplicates, leaving 1784 for screening. Of these, 1593 articles were excluded, and 191 were retrieved to evaluate eligibility. After this evaluation, 76 articles were included in the review. No statistical analysis was performed.

Results: This structured review revealed a range of surgical interventions available for CLBP. These interventions included fusion, stabilization, posterior interspinous devices, and nonoperative management, such as intensive rehabilitation and cognitive behavioral therapy. The evidence suggests that although spinal fusions are not superior in terms of Oswestry Disability Index function or pain level, they do outperform nonoperative management without intensive rehabilitation therapy. This finding is significant because it highlights the potential of surgical strategies to complement other treatments, such as pharmacological and noninterventional procedures, in managing CLBP.

Conclusions: The current evidence strongly advocates for a comprehensive approach to the management of CLBP. Patients with CLBP should be evaluated for surgical approaches when anatomical causes have been identified and multidisciplinary strategies have been implemented. It is reassuring to note that emerging multimodal strategies are beginning to complement neurosurgery care, and they should be integrated into the treatment plan as more substantial evidence becomes available. This emphasis on a multidisciplinary approach underscores the importance of considering all available strategies in CLBP management.