File(s) not publicly available

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

journal contribution
posted on 12.05.2022, 23:17 by David B Anderson, Katie de LucaKatie de Luca, Rikke K Jensen, Jillian P Eyles, James M Van Gelder, Jana L Friedly, Christopher G Maher, Manuela L Ferreira
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.

History

Volume

21

Issue

3

Start Page

455

End Page

464

Number of Pages

10

eISSN

1878-1632

ISSN

1529-9430

Publisher

Elsevier

Language

en

Peer Reviewed

Yes

Open Access

No

Acceptance Date

17/10/2020

External Author Affiliations

Sydney Spine Institute; University of Sydney; The University of Washington, USA

Era Eligible

Yes

Medium

Print-Electronic

Journal

Spine Journal