A critical appraisal of clinical practice guidelines for the treatment of lumbar spinal stenosis

David B Anderson; Katie De Luca; Rikke K Jensen; Jillian P Eyles; James M Van Gelder; Jana L Friedly; Christopher G Maher; Manuela L Ferreira

doi:10.1016/j.spinee.2020.10.022

A critical appraisal of clinical practice guidelines for the treatment of lumbar spinal stenosis

Spine J. 2021 Mar;21(3):455-464. doi: 10.1016/j.spinee.2020.10.022. Epub 2020 Oct 26.

Authors

David B Anderson¹, Katie De Luca², Rikke K Jensen³, Jillian P Eyles⁴, James M Van Gelder⁵, Jana L Friedly⁶, Christopher G Maher⁷, Manuela L Ferreira⁴

Affiliations

¹ Institute for Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Sydney Spine Institute, Sydney, New South Wales, Australia. Electronic address: dand3231@uni.sydney.edu.au.
² Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia.
³ Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
⁴ Institute for Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁵ Sydney Spine Institute, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales.
⁶ Department of Rehabilitation Medicine, The University of Washington, Seattle, WA, USA.
⁷ Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 33122056
DOI: 10.1016/j.spinee.2020.10.022

Abstract

Objective: The aim of the review was to appraise clinical practice guidelines and their recommendations for the treatment of lumbar spinal stenosis.

Methods: PubMed, Medline, CINAHL, Embase, and Cochrane Central Register of Controlled Trials were searched up until 25/01/2020 for clinical practice guidelines on the management of lumbar spinal stenosis with a systematic process to generate recommendations and were publicly available.

Results: Ten guidelines were included, with a total of 76 recommendations for the treatment of lumbar spinal stenosis. Only 4 of the 10 guidelines were of satisfactory methodological quality according to the AGREE II instrument. Around three-quarters of recommendations (72.4%) were presented with poor evidence, with the remaining 21 presenting (27.6%) fair evidence. No recommendation presented good evidence. Recommendations were made on four types of interventions: surgery, injections, medications, and other nonsurgical treatments, with supporting evidence similar for all four treatment types. Positive recommendations were more common for injections (12/13=92.3%) and surgery (10/15=66%) than for nonsurgical treatments (6/21=28.6%) or medications (1/27=3.75%).

Conclusions: Ten guidelines on the management of lumbar spinal stenosis were identified in the systematic review, but only four were of adequate methodological quality. While the evidence underpinning the various types of interventions was similar, guidelines tended to endorse surgery and injections but not nonsurgical interventions and medicines. These results support the need for greater rigor and inclusion of steps to minimize bias in the production of guidelines.

Keywords: AGREE II; Low back pain; Lumbar spinal stenosis; Practice guidelines; Surgery.

Publication types

Systematic Review

MeSH terms

Humans
Injections, Epidural
Pain Management
Spinal Stenosis* / therapy