Advertisement

European Spine Journal

, Volume 25, Issue 11, pp 3495–3512 | Cite as

Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis

  • Matthew FernandezEmail author
  • Manuela L. Ferreira
  • Kathryn M. Refshauge
  • Jan Hartvigsen
  • Isabela R. C. Silva
  • Chris G. Maher
  • Bart W. Koes
  • Paulo H. Ferreira
Review Article

Abstract

Purpose

Previous reviews have compared surgical to non-surgical management of sciatica, but have overlooked the specific comparison between surgery and physical activity-based interventions.

Methods

Systematic review using MEDLINE, CINAHL, Embase and PEDro databases was conducted. Randomised controlled trials comparing surgery to physical activity, where patients were experiencing the three most common causes of sciatica—disc herniation, spondylolisthesis and spinal stenosis. Two independent reviewers extracted pain and disability data (converted to a common 0–100 scale) and assessed methodological quality using the PEDro scale. The size of the effects was estimated for each outcome at three different time points, with a random effects model adopted and the GRADE approach used in summary conclusions.

Results

Twelve trials were included. In the short term, surgery provided better outcomes than physical activity for disc herniation: disability [WMD −9.00 (95 % CI −13.73, −4.27)], leg pain [WMD −16.01 (95 % CI −23.00, −9.02)] and back pain [WMD −12.44 (95 % CI −17.76, −7.09)]; for spondylolisthesis: disability [WMD −14.60 (95 % CI −17.12, −12.08)], leg pain [WMD −35.00 (95 % CI −39.66, −30.34)] and back pain [WMD −20.00 (95 % CI −24.66, −15.34)] and spinal stenosis: disability [WMD −11.39 (95 % CI −17.31, −5.46)], leg pain [WMD, −27.17 (95 % CI −35.87, −18.46)] and back pain [WMD −20.80 (95 % CI −25.15, −16.44)]. Long-term and greater than 2-year post-randomisation results favoured surgery for spondylolisthesis and stenosis, although the size of the effects reduced with time. For disc herniation, no significant effect was shown for leg and back pain comparing surgery to physical activity.

Conclusion

There are indications that surgery is superior to physical activity-based interventions in reducing pain and disability for disc herniation at short-term follow-up only; but high-quality evidence in this field is lacking (GRADE). For spondylolisthesis and spinal stenosis, surgery is superior to physical activity up to greater than 2 years follow-up. Results should guide clinicians and patients when facing the difficult decision of having surgery or engaging in active care interventions.

PROSPERO registration number : CRD42013005746.

Keywords

Sciatica Surgery Physical activity Systematic review Meta-analysis 

Notes

Compliance with ethical standards

Funding

MF is a PhD student supported by the Chiropractic and Osteopathic College of Australasia (COCA) Research Limited. CGM is supported by a research fellowship funded by the Australian Research Council.

Conflict of interest

All authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Supplementary material

586_2015_4148_MOESM1_ESM.doc (36 kb)
Supplementary material 1 (DOC 36 kb)
586_2015_4148_MOESM2_ESM.doc (60 kb)
Supplementary material 2 (DOC 59 kb)
586_2015_4148_MOESM3_ESM.docx (16 kb)
Supplementary material 3 (DOCX 15 kb)
586_2015_4148_MOESM4_ESM.docx (28 kb)
Supplementary material 4 (DOCX 27 kb)

References

  1. 1.
    Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, McLachlan AJ, Koes B, Ferreira PH (2012) Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med 157:865–877CrossRefPubMedGoogle Scholar
  2. 2.
    Koes BW, van Tulder MW, Peul WC (2007) Diagnosis and treatment of sciatica. BMJ 334:1313–1317. doi: 10.1136/bmj.39223.428495.BE CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ong BN, Konstantinou K, Corbett M, Hay E (2011) Patients’ own accounts of sciatica: a qualitative study. Spine 36:1251–1256. doi: 10.1097/BRS.0b013e318204f7a2 CrossRefPubMedGoogle Scholar
  4. 4.
    Verwoerd AJ, Luijsterburg PA, Lin CW, Jacobs WC, Koes BW, Verhagen AP (2013) Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica. Eur J Pain 17:1126–1137. doi: 10.1002/j.1532-2149.2013.00301.x CrossRefPubMedGoogle Scholar
  5. 5.
    Valat JP, Genevay S, Marty M, Rozenberg S, Koes B (2010) Sciatica. Best Pract Res Clin Rheumatol 24:241–252. doi: 10.1016/j.berh.2009.11.005 CrossRefPubMedGoogle Scholar
  6. 6.
    Visser LH, Nijssen PG, Tijssen CC, van Middendorp JJ, Schieving J (2013) Sciatica-like symptoms and the sacroiliac joint: clinical features and differential diagnosis. Eur Spine J 22:1657–1664. doi: 10.1007/s00586-013-2660-5 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Cannon DEBS, Dillingham TRMD, Miao HMS, Andary MTMD, Pezzin LEP (2007) Musculoskeletal disorders in referrals for suspected lumbosacral radiculopathy. Am J Phys Med Rehabil 86:957–961CrossRefPubMedGoogle Scholar
  8. 8.
    Swezey RLMD (2003) Overdiagnosed sciatica and stenosis, underdiagnosed hip arthritis. Orthopedics 26:173–174PubMedGoogle Scholar
  9. 9.
    Ashworth J, Konstantinou K, Dunn KM (2011) Prognostic factors in non-surgically treated sciatica: a systematic review. BMC Musculoskelet Disord 12:208. doi: 10.1186/1471-2474-12-208 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Luijsterburg PA, Verhagen AP, Ostelo RW, van Os TA, Peul WC, Koes BW (2007) Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J 16:881–899. doi: 10.1007/s00586-007-0367-1 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Pinto RZ, Maher CG, Ferreira ML, Ferreira PH, Hancock M, Oliveira VC, McLachlan AJ, Koes B (2012) Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ 344:e497. doi: 10.1136/bmj.e497 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Caspersen CJ, Powell KE, Christenson GM (1985) Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 100:126–131PubMedPubMedCentralGoogle Scholar
  13. 13.
    Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW, Leiden-The Hague Spine Intervention Prognostic Study G (2007) Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 356:2245–2256Google Scholar
  14. 14.
    Jacobs WC, van Tulder M, Arts M, Rubinstein SM, van Middelkoop M, Ostelo R, Verhagen A, Koes B, Peul WC (2011) Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J 20:513–522. doi: 10.1007/s00586-010-1603-7 CrossRefPubMedGoogle Scholar
  15. 15.
    Birkmeyer NJ, Weinstein JN, Tosteson AN, Tosteson TD, Skinner JS, Lurie JD, Deyo R, Wennberg JE (2002) Design of the spine patient outcomes research trial (SPORT). Spine 27:1361–1372CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hamilton MT, Booth FW (2000) Skeletal muscle adaptation to exercise: a century of progress. J Appl Physiol 88:327–331PubMedGoogle Scholar
  17. 17.
    Choi BK, Verbeek JH, Tam WW, Jiang JY (2010) Exercises for prevention of recurrences of low-back pain. Occup Environ Med 67:795–796. doi: 10.1136/oem.2010.059873 CrossRefPubMedGoogle Scholar
  18. 18.
    Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83:713–721PubMedGoogle Scholar
  19. 19.
    de Morton NA (2009) The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother 55:129–133CrossRefPubMedGoogle Scholar
  20. 20.
    Macedo LG, Elkins MR, Maher CG, Moseley AM, Herbert RD, Sherrington C (2010) There was evidence of convergent and construct validity of Physiotherapy Evidence Database quality scale for physiotherapy trials. J Clin Epidemiol 63:920–925. doi: 10.1016/j.jclinepi.2009.10.005 CrossRefPubMedGoogle Scholar
  21. 21.
    Harvey L, Herbert R, Crosbie J (2002) Does stretching induce lasting increases in joint ROM? A systematic review. Physiother Res Int 7:1–13CrossRefPubMedGoogle Scholar
  22. 22.
    Higgins JP, Green S, (eds) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org
  23. 23.
    Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O’Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer T, Varonen H, Vist GE, Williams JW Jr, Zaza S, Group GW (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490–1494Google Scholar
  24. 24.
    Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ (2010) Behavioural treatment for chronic low-back pain. Cochrane Database of Syst Rev:CD002014.pub002013. doi: 10.1002/14651858.CD002014.pub3
  25. 25.
    Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ, Group GW (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926. doi: 10.1136/bmj.39489.470347.AD CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Giraudeau B, Rozenberg S, Valat JP (2004) Assessment of the clinically relevant change in pain for patients with sciatica. Ann Rheum Dis 63:1180–1181CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine 33:90–94. doi: 10.1097/BRS.0b013e31815e3a10 CrossRefPubMedGoogle Scholar
  28. 28.
    Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F (2000) Lumbar spinal stenosis: conservative or surgical management?: a prospective 10-year study. Spine 25:1424–1435CrossRefPubMedGoogle Scholar
  29. 29.
    Erginousakis D, Filippiadis DK, Malagari A, Kostakos A, Brountzos E, Kelekis NL, Kelekis A, Orthopaedic Section of the American Physical Therapy A (2011) Comparative prospective randomized study comparing conservative treatment and percutaneous disk decompression for treatment of intervertebral disk herniation. Radiology 260:487–493CrossRefPubMedGoogle Scholar
  30. 30.
    Malmivaara A, Slatis P, Heliovaara M, Sainio P, Kinnunen H, Kankare J, Dalin-Hirvonen N, Seitsalo S, Herno A, Kortekangas P, Niinimaki T, Ronty H, Tallroth K, Turunen V, Knekt P, Harkanen T, Hurri H, Finnish Lumbar Spinal Research G (2007) Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine 32:1–8Google Scholar
  31. 31.
    Möller H, Hedlund R (2000) Surgery versus conservative management in adult isthmic spondylolisthesis: a prospective randomized study: part 1. Spine 25:1711–1715CrossRefPubMedGoogle Scholar
  32. 32.
    Osterman H, Seitsalo S, Karppinen J, Malmivaara A (2006) Effectiveness of microdiscectomy for lumbar disc herniation: a randomized controlled trial with 2 years of follow-up. Spine 31:2409–2414CrossRefPubMedGoogle Scholar
  33. 33.
    Weber H (1983) Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine 8:131–140CrossRefPubMedGoogle Scholar
  34. 34.
    Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257–2270CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H, Investigators S (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358:794–810. doi: 10.1056/NEJMoa0707136 CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom B, Skinner JS, Abdu WA, Hilibrand AS, Boden SD, Deyo RA (2006) Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA 296:2441–2450CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Peul WC, van den Hout WB, Brand R, Thomeer RT, Koes BW, Leiden-The Hague Spine Intervention Prognostic Study G (2008) Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ 336:1355–1358Google Scholar
  38. 38.
    Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, Herkowitz H, Hilibrand A, Albert T, Fischgrund J (2008) Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine 33:2789–2800CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, Birkmeyer N, Herkowitz H, Longley M, Lenke L, Emery S, Hu SS (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91:1295–1304. doi: 10.2106/JBJS.H.00913 CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H (2010) Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine 35:1329–1338. doi: 10.1097/BRS.0b013e3181e0f04d CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Mariconda M, Fava R, Gatto A, Longo C, Milano C (2002) Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients. J Spinal Disord Tech 15:39–46CrossRefPubMedGoogle Scholar
  42. 42.
    Greenfield K, Nelson RJ, Findlay GD, Egger M, Sanford E (2003) Microdiscectomy and conservative treatment for lumbar disc herniation with back pain and sciatica: a randomised clinical trial. In: Proceedings of the 30th meeting of the International Society for the Study of the Lumbar Spine, Vancouver 245. http://www.issls.org
  43. 43.
    Lequin MB, Verbaan D, Jacobs WCH, Brand R, Bouma GJ, Vandertop WP, Peul WC (2013) Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. BMJ Open 3. doi: 10.1136/bmjopen-2012-002534
  44. 44.
    Slatis P, Malmivaara A, Heliovaara M, Sainio P, Herno A, Kankare J, Seitsalo S, Tallroth K, Turunen V, Knekt P, Hurri H (2011) Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial. Eur Spine J 20:1174–1181CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD (2009) Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine 34:1094–1109CrossRefPubMedGoogle Scholar
  46. 46.
    Gibson JN, Waddell G Gibson JNA, Waddell G (2007) Surgical interventions for lumbar disc prolapse. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD001350. doi: 10.1002/14651858.CD001350.pub4
  47. 47.
    Lewis R, Williams N, Matar H, Din N, Fitzsimmons D, Phillips C, Jones M, Sutton A, Burton K, Nafees S, Hendry M, Rickard I, Chakraverty R, Wilkinson C (2011) The clinical effectiveness and costeffectiveness of management strategies for sciatica: systematic review and economic model. Health Technol Assess 15:1–578CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    May S, Comer C (2013) Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review. Physiotherapy 99:12–20CrossRefPubMedGoogle Scholar
  49. 49.
    Macedo LG, Hum A, Kuleba L, Mo J, Truong L, Yeung M, Battie MC (2013) Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review. Phys Ther 93:1646–1660. doi: 10.2522/ptj.20120379 CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Kovacs FM, Urrutia G, Alarcon JD (2011) Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine 36:E1335–E1351. doi: 10.1097/BRS.0b013e31820c97b1 CrossRefPubMedGoogle Scholar
  51. 51.
    Ammendolia C, Stuber K, de Bruin LK, Furlan AD, Kennedy CA, Rampersaud YR, Steenstra IA, Pennick V (2012) Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: a systematic review. Spine 37:E609–E616. doi: 10.1097/BRS.0b013e318240d57d CrossRefPubMedGoogle Scholar
  52. 52.
    Ferreira ML, Herbert RD, Ferreira PH, Latimer J, Ostelo RW, Grotle M, Barrett B (2013) The smallest worthwhile effect of nonsteroidal anti-inflammatory drugs and physiotherapy for chronic low back pain: a benefit–harm trade-off study. J Clin Epidemiol 66:1397–1404CrossRefPubMedGoogle Scholar
  53. 53.
    Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the Maine Lumbar Spine Study. Spine 30:936–943CrossRefPubMedGoogle Scholar
  54. 54.
    Deyo RA, Martin BI, Kreuter W, Jarvik JG, Angier H, Mirza SK (2011) Revision surgery following operations for lumbar stenosis. J Bone Joint Surg Am 93:1979–1986. doi: 10.2106/JBJS.J.01292 CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:1259–1265. doi: 10.1001/jama.2010.338 CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Moore JA, Albert TJ, Radcliff K (2014) The value and cost-effectiveness of adult degenerative lumbar surgery. Semin Spine Surg 26:38–44CrossRefGoogle Scholar
  57. 57.
    Tosteson AN, Tosteson TD, Lurie JD, Abdu W, Herkowitz H, Andersson G, Albert T, Bridwell K, Zhao W, Grove MR, Weinstein MC, Weinstein JN (2011) Comparative effectiveness evidence from the spine patient outcomes research trial: surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation. Spine 36:2061–2068. doi: 10.1097/BRS.0b013e318235457b CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    van Den Hout WB , Peul WC, Koes BW, Brand R, Kievit J, Thomeer RT (2008) Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial. BMJ 336:1351–1354. doi: 10.1136/bmj.39583.709074.BE CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Hansson E, Hansson T (2007) The cost–utility of lumbar disc herniation surgery. Eur Spine J 16:329–337CrossRefPubMedGoogle Scholar
  60. 60.
    Laupacis A, Feeny D, Detsky AS, Tugwell PX (1992) How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J 146:473–481Google Scholar
  61. 61.
    Hofstede SN, Marang-van de Mheen PJ, Assendelft WJ, Vleggeert-Lankamp CL, Stiggelbout AM, Vroomen PC, van den Hout WB, Vliet Vlieland TP, van Bodegom-Vos L, Group Ds (2012) Designing an implementation strategy to improve interprofessional shared decision making in sciatica: study protocol of the DISC study. Implementation Science 7:55CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Pearson A, Lurie J, Tosteson T, Zhao W, Abdu W, Mirza S, Weinstein J (2012) Who should have surgery for an intervertebral disc herniation?: comparative effectiveness evidence from the spine patient outcomes research trial. Spine 37(140–149):1. doi: 10.1097/BRS.1090b1013e3182276b3182272b Google Scholar
  63. 63.
    Pearson AM, Lurie JD, Tosteson TD, Zhao W, Abdu WA, Weinstein JN (2013) Who should undergo surgery for degenerative spondylolisthesis? Treatment effect predictors in SPORT. Spine 38(1799–1811):17. doi: 10.1097/BRS.1790b1013e3182a1314d1790 Google Scholar
  64. 64.
    Pearson A, Lurie J, Tosteson T, Zhao W, Abdu W, Weinstein JN (2012) Who should have surgery for spinal stenosis? Treatment effect predictors in SPORT. Spine 37(1791–1802):17. doi: 10.1097/BRS.1790b1013e3182634b3182604 Google Scholar
  65. 65.
    Watters WC 3rd, Bono CM, Gilbert TJ, Kreiner DS, Mazanec DJ, Shaffer WO, Baisden J, Easa JE, Fernand R, Ghiselli G, Heggeness MH, Mendel RC, O’Neill C, Reitman CA, Resnick DK, Summers JT, Timmons RB, Toton JF, North American Spine S (2009) An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J 9:609–614. doi: 10.1016/j.spinee.2009.03.016 CrossRefPubMedGoogle Scholar
  66. 66.
    Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, Cho CH, DePalma MJ, Dougherty P, Fernand R, Ghiselli G, Hanna AS, Lamer T, Lisi AJ, Mazanec DJ, Meagher RJ, Nucci RC, Patel RD, Sembrano JN, Sharma AK, Summers JT, Taleghani CK, Tontz WL, Toton JF (2014) An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J 14:180–191CrossRefPubMedGoogle Scholar
  67. 67.
    Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, Hwang SW, Mendel RC, Reitman CA, North American Spine S (2013) An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 13:734–743. doi: 10.1016/j.spinee.2012.11.059 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Matthew Fernandez
    • 1
    Email author
  • Manuela L. Ferreira
    • 2
    • 6
  • Kathryn M. Refshauge
    • 1
  • Jan Hartvigsen
    • 3
    • 4
  • Isabela R. C. Silva
    • 1
  • Chris G. Maher
    • 2
  • Bart W. Koes
    • 5
  • Paulo H. Ferreira
    • 1
  1. 1.Faculty of Health ScienceUniversity of SydneySydneyAustralia
  2. 2.The George Institute for Global Health, Sydney Medical SchoolUniversity of SydneySydneyAustralia
  3. 3.Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdense MDenmark
  4. 4.Nordic Institute of Chiropractic and Clinical BiomechanicsOdense MDenmark
  5. 5.Department of General PracticeErasmus University Medical CentreRotterdamThe Netherlands
  6. 6.The Institute of Bone and Joint Research, Sydney Medical SchoolUniversity of SydneySydneyAustralia

Personalised recommendations