Evidence note 36
What is the evidence base for the use of orthopaedic spinal
surgery for mechanical low back pain or degenerative
This evidence note summarises the published
clinical and cost-effectiveness evidence on spinal fusion, disc
replacement and interspinous distraction devices in the lumbar
spine for adult patients with mechanical low back pain or
degenerative spondylolisthesis. Mechanical low back pain describes
pain in the joints, discs and/ or connective tissues of the lower
spine for which no specific cause has been found. Degenerative
spondylolisthesis describes one vertebra slipping forward over
another as a result of aging. It is one of a set of degenerative
conditions affecting the lumbar spine, which may be collectively
described as degenerative disc disease or degenerative spondylosis.
This evidence note does not cover the condition spinal stenosis
without degenerative spondylolisthesis. Neither does it consider
the comparison of all surgery with conservative management; nor
specific techniques for fusion surgery with each other.
- In mechanical low back pain which has persisted despite optimal
conservative management, there is evidence that spinal fusion can
be of benefit.
- In chronic low back pain, spinal fusion is unlikely to be cost
effective versus intensive rehabilitation over a 2-year time
horizon; however there is some indication that it could become cost
effective over a longer term time horizon
- In degenerative spondylolisthesis, there is evidence that
spinal fusion as an adjunct to decompression leads to better
clinical outcomes than decompression alone.
- Evidence for clinical effectiveness of disc replacement and
interspinous distraction devices was minimal. It was neither
specific to degenerative spondylolisthesis, nor necessarily
generalisable to mechanical low back pain.
- No cost-effectiveness evidence was identified on spinal fusion,
disc replacement or interspinous distraction devices in the
treatment of degenerative spondylolisthesis.
The content of this evidence
note was accurate and based upon the most up to date evidence
available at the date of first publication. Readers are asked to
consider that new trials and technologies may have emerged since
first publication and the evidence presented may no longer be
Published Date: 27 May 2011