European Spine Journal

, Volume 15, Supplement 1, pp S82–S92 | Cite as

Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review

  • Maurits W. van Tulder
  • Bart Koes
  • Seppo Seitsalo
  • Antti Malmivaara


Within the framework of evidence-based medicine high-quality randomised trials and systematic reviews are considered a necessary prerequisite for progress in orthopaedics. This paper summarises the currently available evidence on surgical and other invasive procedures for low back pain. Results of systematic reviews conducted within the framework of the Cochrane Back Review Group were used. Data were gathered from the latest Cochrane Database of Systematic Reviews 2005, Issue 2. The Cochrane reviews were updated using the evidence summary on surgery and other invasive procedures from the COST B13 European Guidelines for the Management of Acute and Chronic Non-Specific Low Back Pain. Facet joint, epidural, trigger point and sclerosant injections have not clearly been shown to be effective and can consequently not be recommended. There is no scientific evidence on the effectiveness of spinal stenosis surgery. Surgical discectomy may be considered for selected patients with sciatica due to lumbar disc prolapses that fail to resolve with the conservative management. Cognitive intervention Combined with exercises is recommended for chronic low back pain, and fusion surgery may be considered only in carefully selected patients after active rehabilitation programmes during 2 years time have failed. Demanding surgical fusion techniques are not better than the traditional posterolateral fusion without internal fixation.


Back pain Sciatica Invasive treatment Surgery Evidence review 


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Maurits W. van Tulder
    • 1
    • 2
  • Bart Koes
    • 3
  • Seppo Seitsalo
    • 4
  • Antti Malmivaara
    • 5
  1. 1.Institute for Research in Extramural Medicine (EMGO)VU University Medical Center AmsterdamThe Netherlands
  2. 2.Institute for Health Sciences, Faculty of Earth & Life SciencesFree UniversityAmsterdamThe Netherlands
  3. 3.Department of General PracticeErasmus University Medical Center RotterdamRotterdamThe Netherlands
  4. 4.ORTON Orthopaedic HospitalHelsinkiFinland
  5. 5.Finnish Office for Health Care Technology AssessmentStakesFinland

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