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

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Abstract

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.

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References

  1. 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 25:1424–1435

    Article  PubMed  CAS  Google Scholar 

  2. Barendse GAM, van den Berg SGM, Kessels AHF, Weber WEJ, van Kleef M (2001) Randomized controlled trial of percutaneous intradiscal radiofrequency thermocoagulation for chronic discogenic back pain: lack of effect from a 90-second 70 C lesion. Spine 26:287–292

    Article  PubMed  CAS  Google Scholar 

  3. Béliveau P (1971) A comparison between epidural anaesthesia with and without corticosteroid in the treatment of sciatica. Rheumatol Phys Med 11:40–43

    Article  PubMed  Google Scholar 

  4. Benoist M, Bonneville JF, Lassale B, Runge M, Gillard C, Vazquez Suarez J, Deburge A (1993) A randomized, double-blind study to compare low-dose with standard-dose chymopapain in the treatment of herniated lumbar intervertebral discs. Spine 18:28–34

    Article  PubMed  CAS  Google Scholar 

  5. Bontoux D, Alcalay M, Debiais F, Garrouste O, Ingrand P, Azais I, Roualdes G (1990) Treatment of lumbar disk hernia by intra-disk injection of chymopapain or triamcinolone hexacetonide. Comparative study of 80 cases [Traitement des hernies discales lombaires par injection intradiscale de chymopapaine ou d’hexacetonide de triamcinolone. Etude comparee de 80 cas]. Rev Rhum Mal Osteoartic 57:327–331

    PubMed  CAS  Google Scholar 

  6. Bourgeois P, Benoist M, Palazzo E, Belmatoug N, Folinais D, Frot B, Busson G, Lassale P, Montagner C, Binoche T (1988) Multicenter randomized double-blind study of triamcinolone hexacetonide versus chymopapain in the treatment of disk lumbosciatica. Initial results at 6 months [Etude en double aveugle randomisee multicentrique de l’hexacetonide de triamcinolone versus chymopapaine dans le traitement de la lombosciatique discale. Premiers resultats a six mois]. Rev Rhum Mal Osteoartic 55:767–769

    PubMed  CAS  Google Scholar 

  7. Bouter LM, Pennick V, Bombardier C, Editorial Board of the Back Review Group (2003) Cochrane Back Review Group. Spine 28:1215–1218

    Article  PubMed  Google Scholar 

  8. Breivik H, Hesla PE, Molnar I, Lind B (1976) Treatment of chronic low back pain and sciatica: comparison of caudal epidural injections of bupivacaine and methylprednisolone with bupibvacaine followed by saline. Adv Pain Res Ther 1:927–932

    Google Scholar 

  9. Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C (1993) The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6:461–472

    PubMed  CAS  Google Scholar 

  10. Bromley JW, Varma AO, Santoro AJ, Cohen P, Jacobs R, Berger L (1984) Double-blind evaluation of collagenase injections for herniated lumbar discs. Spine 9:486–488

    Article  PubMed  CAS  Google Scholar 

  11. Brox JI, Sorensen R, Friis A, Nygaard O, Indahl A, Keller A, Ingebrigtsen T, Eriksen HR, Holm I, Koller AK, Riise R, Reikeras O (2003) Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 28:1913–1921

    Article  PubMed  Google Scholar 

  12. Bush K, Hillier S (1991) A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica. Spine 15:572–575

    Article  Google Scholar 

  13. Carragee EJ (1997) Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomised study. J Bone Joint Surg 79A:1175–1180

    Google Scholar 

  14. Carette S, Marcoux S, Truchon R, Grondin C, Gagnon J, Allard Y, Latulippe M (1991) A controlled trial of corticosteroid injections into facet joints for chronic low back pain. New Engl J Med 325:1002–1007

    PubMed  CAS  Google Scholar 

  15. Carette S, Leclaire R, Marcoux S (1997) Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. New Engl J Med 336:1634–1640

    Article  PubMed  CAS  Google Scholar 

  16. Chatterjee S, Foy PM, Findlay GF (1995) Report of a controlled clinical trial comparing automated percutaneous lumbar discectomy and microdiscectomy in the treatment of contained lumbar disc herniation. Spine 20:734–738

    Article  PubMed  CAS  Google Scholar 

  17. Christensen FB, Hansen ES, Eiskjaer SP, Hoy K, Helmig P, Neumann P, Niedermann B, Bunger CE (2002) Circumferential lumbar spinal fusion with ALIF Brantigan cage versus posterolateral fusion with titanium CD-Horizon: a prospective, randomized, clinical study of 146 patients. Spine 27:2674–2683

    Article  PubMed  Google Scholar 

  18. Collée G, Dijkmans BAC, Vandenbroucke JP, Cats A (1991) lliac crest pain syndrome in low back pain. A double blind, randomized study of local injection therapy. J Rheumatol 18:1060–1063

    PubMed  Google Scholar 

  19. Crawshaw C, Frazer AM, Merriam WF, Mulholland RC, Webb JK (1984) A comparison of surgery and chemonucleolysis in the treatment of sciatica. A prospective randomized trial. Spine 9:195–198

    Article  PubMed  CAS  Google Scholar 

  20. Cuckler JM, Bernini PA, Wiesel SW, Booth RE, Rothman RH, Pickens GT (1985) The use of epidural steroids in the treatment of lumbar radicular pain. J Bone Joint Surg 67A:63–66

    Google Scholar 

  21. Dabezies EJ, Langford K, Morris J, Shields CB, Wilkinson HA (1988) Safety and efficacy of chymopapain (Discase) in the treatment of sciatica due to a herniated nucleus pulposus. Results of a randomized, double-blind study. Spine 13:561–565

    Article  PubMed  CAS  Google Scholar 

  22. Dallas TL, Lin RL, Wu WH, Wolskee P (1987) Epidural morphine and methylprednisolone for low-back pain. Anaesthesiology 67:408–411

    Article  CAS  Google Scholar 

  23. Dechow E, Davies RK, Carr AJ, Thompson PW (1999) A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology (Oxford) 38:1255–1259

    Article  CAS  Google Scholar 

  24. Ejeskar A, Nachemson A, Herberts P, Lysell E, Andersson G, Irstam L, Peterson LE (1983) Surgery versus chemonucleolysis for herniated lumbar discs. A prospective study with random assignment. Clin Orthop 174:236–242

    PubMed  Google Scholar 

  25. Fairbank J (1999) Spine update: randomized controlled trials in the surgical management of spinal problems. Spine 24:25–56

    Article  Google Scholar 

  26. Fairbank JC, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R (2005) Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 330:1233

    Article  PubMed  Google Scholar 

  27. Feldman J, Menkes CJ, Pallardy G, Chevrot A, Horreard P, Zenny JC, Godefroy D, Amor B (1986) Double-blind study of the treatment of disc lumbosciatica by chemonucleolysis [Etude en double-aveugle du traitement de la lombosciatique discale par chimionucleolyse]. Rev Rhum Mal Osteoartic 53:147–152

    PubMed  CAS  Google Scholar 

  28. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT (1997) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:2807–2812

    Article  PubMed  CAS  Google Scholar 

  29. France JC, Yaszemski MJ, Lauerman WC, Cain JE, Glover JM, Lawson KJ, Coe JD, Topper SM (1999) A randomized prospective study of posterolateral lumbar fusion: outcomes with and without pedicle screw instrumentation. Spine 24:553–560

    Article  PubMed  CAS  Google Scholar 

  30. Fraser RD (1982) Chymopapain for the treatment of intervertebral disc herniation. A preliminary report of a double-blind study. Spine 7:608–612

    Article  PubMed  CAS  Google Scholar 

  31. Freeman BJC, Fraser RD, Cain CMJ, Hall DJ (2003) A randomised double-blind controlled efficacy study: intradiscal electrothermal therapy (IDET) versus placebo. J Bone Joint Surg 85B(Supp III):280

    Google Scholar 

  32. Fritzell P, Hagg O, Wessberg P, Nordwall A (2001) Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine 26:2521–2532

    Article  PubMed  CAS  Google Scholar 

  33. Frost FA, Jessen B, Siggaard-Andersen J (1980) A control, double-blind comparison of mepivacaine injection versus saline injection for myofascial pain. Lancet 1(8167):499–500

    Article  PubMed  CAS  Google Scholar 

  34. Gallagher J, Petriccione di Vadi PL, Wedley JR (1994) Radiofrequency facet joint denervation in the treatment of low back pain: a prospective controlled double-blind study to assess its efficacy. Pain Clin 7:193–198

    Google Scholar 

  35. Garvey TA, Marks MR, Wiesel SW (1989) A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain. Spine 14:962–964

    Article  PubMed  CAS  Google Scholar 

  36. Gibson JN, Grant IC, Waddell G (2000) Surgery for lumbar disc prolapse. Cochrane Database Syst Rev, Issue 3

  37. Gibson JNA, Waddell G (2005) Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev, Issue 2

  38. Glynn Ch, Dawson D, Sanders R (1988) A double-blind comparison between epidural morphine and epidural clonidine in patients with chronic non-cancer pain. Pain 34:123–128

    Article  Google Scholar 

  39. Goodwin CB, Brighton CT, Guyer RD, Johnson JR, Light KI, Yuan HA (1999) A double-blind study of capacitively coupled electrical stimulation as an adjunct to lumbar spinal fusions. Spine 24:1349–1357

    Article  PubMed  CAS  Google Scholar 

  40. Grob D, Humke T, Dvorak J (1995) Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg 77A:1036–1041

    Google Scholar 

  41. Hameroff SR, Crago BR, Blitt CD, Womble J, Kanel J (1981) Comparison of bupivacaine, etidocaine, and saline for trigger-point therapy. Anaesth Analg 60:752–755

    Article  CAS  Google Scholar 

  42. Heavner JE, Racz GB, Raj P (1999) Percutaneous epidural neuroplasty: prospective evaluation of 0.9% NaCl versus 10% NaCl with or without hyaluronidase. Reg Anesth Pain Med 24:202–207

    Article  PubMed  CAS  Google Scholar 

  43. Hedtmann A, Fett H, Steffen R, Kramer J (1992) Chemonucleolysis using chymopapain and collagenase. 3-Year results of a prospective randomized study [Chemonukleolyse mit Chymopapain und Kollagenase. 3-Jahres-Ergebnisse einer prospektiv-randomisierten Studie]. Z Orthop Ihre Grenzgeb 130:36–44

    PubMed  CAS  Google Scholar 

  44. Henrikson L, Schmidt V, Eskesen V, Jantzen E (1996) A controlled study of microsurgical versus standard lumbar discectomy. Br J Neurosurg 10:289–293

    Article  Google Scholar 

  45. Herkowitz HN, Kurz LT (1991) Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 73A:802–808

    Google Scholar 

  46. Javid MJ, Nordby EJ, Ford LT, Hejna WJ, Whisler WW, Burton C (1983) Safety and efficacy of chymopapain (chymodiactin) in herniated nucleus pulposus with sciatica. JAMA 249:2489–2494

    Article  PubMed  CAS  Google Scholar 

  47. Jenis LG, An HS, Stein R, Young B (2000) Prospective comparison of the effect of direct current electrical stimulation and pulsed electromagnetic fields on instrumented posterolateral lumbar arthrodesis. J Spinal Disord 13:290–296

    Article  PubMed  CAS  Google Scholar 

  48. Karppinen J, Malmivaara A, Kurunlahti M, Kyllonen E, Pienimaki T, Nieminen P, Ohinmaa A, Tervonen O, Vanharanta H (2001) Periradicular infiltration for sciatica: a randomized controlled trial. Spine 26:1059–1067

    Article  PubMed  CAS  Google Scholar 

  49. Keller A, Brox JI, Gunderson R, Holm I, Friis A, Reikeras O (2004) Trunk muscle strength, cross-sectional area and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine 29:3–8

    Article  PubMed  Google Scholar 

  50. Khot A, Bowditch M, Powell J, Sharp D (2004) The use of intradiscal steroid therapy for lumbar spinal discogenic pain: a randomized controlled trial. Spine 29:833–836

    Article  PubMed  Google Scholar 

  51. Kitchel SH, Matteri RE (2002) Prospective randomized evaluation of PLIF in degenerative spondylolisthesis patients over 60 years old. Curr Concepts Rev

  52. Klein RG, Eek BC, DeLong WB, Mooney V (1993) A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord 6:23–33

    Article  PubMed  CAS  Google Scholar 

  53. Kotilainen E, Muittari P, Kirvela O (1997) Intradiscal glycerol or bupivacaine in the treatment of low back pain. Acta Neurochir (Wien) 139:541–545

    Article  CAS  Google Scholar 

  54. Kraemer J, Ludwig J, Bickert U, Owczarek V, Traupe M (1997) Lumbar epidural perineural injection: a new technique. Eur Spine J 6:357–361

    Article  PubMed  CAS  Google Scholar 

  55. Lagarrigue J, Chaynes P (1994) Comparative study of disk surgery with or without microscopy. A prospective study of 80 cases [Etude comparative de la chirurgie discale avec et sans microscope]. Neurochirurgie 40:116–120

    PubMed  CAS  Google Scholar 

  56. Lavignolle B, Vital JM, Baulny D, Grenier F, Castagnera L (1987) Comparative study of surgery and chemonucleolysis in the treatment of sciatica caused by a herniated disk [Etudes comparees de la chirurgie et de la chimionucleolyse dans le traitement de la sciatique par hernie discale]. Acta Orthop Belg 53:244–249

    PubMed  CAS  Google Scholar 

  57. Leclaire R, Fortin L, Lambert R (2001) Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy. Spine 26:1411–1416

    Article  PubMed  CAS  Google Scholar 

  58. Lilius G, Lassonen AM, Myllynen P, Harilainen A, Salo L (1989) The lumbar facet joint syndrome––significance of inappropriate signs. A randomized, placebo controlled trial. French J Orthop Surg 3:479–486

    Google Scholar 

  59. Lilius G, Harilainen A, Laasonen EM, Myllynen P (1990) Chronic unilateral low back pain. Predictors of outcome of facet joint injections. Spine 15:780–782

    Article  PubMed  CAS  Google Scholar 

  60. Lord SM, Barnsley L, Wallis BJ (1996) Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med 335:1721–1726

    Article  PubMed  CAS  Google Scholar 

  61. Lutze M, Stendel R, Vesper J, Brock M (1997) Periradicular therapy in lumbar radicular syndromes: methodology and results. Acta Neurochir (Wien) 139:719–724

    Article  CAS  Google Scholar 

  62. Marks RC, Houston T, Thulbourne T (1992) Facet joint injection and facet nerve block: a randomised comparison in 86 patients with chronic low back pain. Pain 49:325–328

    Article  PubMed  CAS  Google Scholar 

  63. Mathews JA, Mills SB, Jenkins VM, Grimes SM, Morkel MJ, Mathews W, Scott CM, Sittampalam Y (1987) Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. Br J Rheum 26:416–423

    Article  CAS  Google Scholar 

  64. Mayer HM, Brock M (1993) Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 78:216–225

    Article  PubMed  CAS  Google Scholar 

  65. McGuire RA, Amundson GM (1993) The use of primary internal fixation in spondylolisthesis. Spine 18:1662–1672

    Article  PubMed  CAS  Google Scholar 

  66. Moller H, Hedlund R (2000) Surgery versus conservative management in adult isthmic spondylolisthesis––a prospective randomized study: part 1. Spine 25:1711–1715

    Article  PubMed  CAS  Google Scholar 

  67. Moller H, Hedlund R (2000) Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis––a prospective randomized study: part 2. Spine 25:1716–1721

    Article  PubMed  CAS  Google Scholar 

  68. Mooney V (1990) A randomized double-blind prospective study of the efficacy of pulsed electromagnetic fields for interbody lumbar fusions. Spine 15:708–712

    Article  PubMed  CAS  Google Scholar 

  69. Muralikuttan KP, Hamilton A, Kernohan WG, Mollan RA, Adair IV (1992) A prospective randomized trial of chemonucleolysis and conventional disc surgery in single level lumbar disc herniation. Spine 17:381–387

    Article  PubMed  CAS  Google Scholar 

  70. Nelemans PJ, de Bie RA, de Vet HC, Sturmans F (2000) Injection therapy for subacute and chronic benign low back pain. Cochrane Database Syst Rev, Issue 2

  71. Niemisto L, Kalso E, Malmivaara A, Seitsalo S, Hurri H (2003) Radiofrequency denervation for neck and back pain: a systematic review within the framework of the Cochrane collaboration back review group. Spine 28:1877–1888

    Article  PubMed  Google Scholar 

  72. Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LJ (1987) A new approach to the treatment of chronic low back pain. Lancet 2(8551):143–146

    Article  PubMed  CAS  Google Scholar 

  73. Pauza KJ, Howell S, Dreyfuss P, Peloza JH, Dawson K, Bogduk N (2004) A randomized, placebo-controlled trial of intradiscal electrotermal therapy for the treatment of discogenic low back pain. Spine J 4:27–35

    Article  PubMed  Google Scholar 

  74. Postacchini F, Cinotti G, Perugia D, Gumina S (1993) The surgical treatment of central lumbar stenosis. J Bone Joint Surg 75B:386–392

    Google Scholar 

  75. Revel M, Payan C, Vallee C, Laredo JD, Lassale B, Roux C (1993) Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica. A randomized multicenter trial. Spine 18:1–7

    Article  PubMed  CAS  Google Scholar 

  76. Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, Goette K (2000) The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg 82A:1589–1593

    Google Scholar 

  77. Rocco AG, Frank E, Kaul AF, Lipson SJ, Gallo JP (1989) Epidural steroids, epidural morphine and epidural steroids combined with morphine in the treatment of post-laminectomy syndrome. Pain 36:297–303

    Article  PubMed  CAS  Google Scholar 

  78. Rogers P, Nash T, Schiller D, Norman J (1992) Epidural steroids for sciatica. Pain Clin 5:67–72

    Google Scholar 

  79. Samwel H, Slappendel R, Crul BJ (2000) Psychological predictors of the effectiveness of radiofrequency lesioning of the cervical spinal dorsal ganglion (RF-DRG). Eur J Pain 4:149–155

    Article  PubMed  CAS  Google Scholar 

  80. Sasso RC, Kitchel SH, Dawson EG (2004) A prospective, randomized controlled clinical trial of anterior lumbar interbody fusion using a titanium cylindrical threaded fusion device. Spine 29:113–122

    Article  PubMed  Google Scholar 

  81. Schofferman J, Slosar P, Reynolds J, Goldthwaite N, Koestler M (2001) A prospective randomized comparison of 270° fusions to 360° fusions (circumferential fusions). Spine 26:E207–E212

    Article  PubMed  CAS  Google Scholar 

  82. Schwetschenau R, Ramirez A, Johnston J, Barnes E, Wiggs C, Martins AN (1976) Double-blind evaluation of intradiscal chymopapain for herniated lumbar discs. Early results. J Neurosurg 45:622–627

    CAS  Google Scholar 

  83. Serrao JM, Marks RL, Morley SJ, Goodchild CS (1992) Intrathecal midazolam for the treatment of chronic mechanical low back pain: a controlled comparison with epidural steroid in a pilot study. Pain 48:5–12

    Article  PubMed  CAS  Google Scholar 

  84. Shealy CN (1975) Percutaneous radiofrequency denervation of spinal facets. Treatment for chronic back pain and sciatica. J Neurosurg 43:448–451

    PubMed  CAS  Google Scholar 

  85. Simmons JW, McMillin JN, Emery SF, Kimmich SJ (1992) Intradiscal steroids: a prospective double-blind clinical trial. Spine 17:172–175

    Article  Google Scholar 

  86. Slappendel R, Crul BJ, Braak GJ (1997) The efficacy of radiofrequency lesioning of the cervical spinal dorsal root ganglion in a double blinded randomized study: no difference between 40 degrees C and 67 degrees C treatments. Pain 73:159–163

    Article  PubMed  CAS  Google Scholar 

  87. Sonne M, Christensen K, Hansen SE, Jensen EM (1985) Injection of steroids and local anaesthetics as therapy for low-back pain. Scand J Rheum 14:343–345

    Article  PubMed  CAS  Google Scholar 

  88. Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bunger CE (1997) The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion. A prospective randomized clinical study. Spine 22:2813–2822

    Article  PubMed  CAS  Google Scholar 

  89. Tullberg T, Isacson J, Weidenhielm L (1993) Does microscopic removal of lumbar disc herniation lead to better results than the standard procedure? Results of a one-year randomized study. Spine 18:24–27

    Article  PubMed  CAS  Google Scholar 

  90. Vad VB, Bhat AL, Lutz GE, Cammisa F (2002) Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 27:11–16

    Article  PubMed  Google Scholar 

  91. Van Alphen HA, Braakman R, Bezemer PD, Broere G, Berfelo MW (1989) Chemonucleolysis versus discectomy: a randomized multicenter trial. J Neurosurg 70:869–875

    PubMed  Google Scholar 

  92. Van Kleef M, Liem L, Lousberg R (1996) Radiofrequency lesion adjacent to the dorsal root ganglion for cervicobrachial pain: a prospective double blind randomized study. Neurosurgery 38:1127–1131

    Article  PubMed  Google Scholar 

  93. Van Kleef M, Barendse GA, Kessels A (1999) Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine 24:1937–1942

    Article  PubMed  Google Scholar 

  94. Wallis BJ, Lord SM, Bogduk N (1997) Resolution of psychological distress of whiplash patients following treatment by radiofrequency neurotomy: a randomised, double-blind, placebo-controlled trial. Pain 73:15–22

    Article  PubMed  CAS  Google Scholar 

  95. Weber H (1978) Lumbar disc herniation. A prospective study of prognostic factors including a controlled trial (see also pp89–120). J Oslo City Hosp 28:33–64

    PubMed  CAS  Google Scholar 

  96. Weber H (1983) Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine 8:131–140

    Article  PubMed  CAS  Google Scholar 

  97. Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M (2004) Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine 29:9–16

    Article  PubMed  Google Scholar 

  98. Yelland MJ, Del Mar C, Pirozzo S, Schoene ML (2004) Prolotherapy injections for chronic low back pain: a systematic review. Spine 29:2126–2133

    Article  PubMed  Google Scholar 

  99. Zdeblick TA (1993) A prospective, randomized study of lumbar fusion. Preliminary results. Spine 18:983–991

    Article  PubMed  CAS  Google Scholar 

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  1. Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands

    Maurits W. van Tulder

  2. Institute for Health Sciences, Faculty of Earth & Life Sciences, Free University, de Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands

    Maurits W. van Tulder

  3. Department of General Practice, Erasmus University Medical Center Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

    Bart Koes

  4. ORTON Orthopaedic Hospital, Tenholantie 10, 00280, Helsinki, Finland

    Seppo Seitsalo

  5. Finnish Office for Health Care Technology Assessment, P.O. Box 220, FIN-00531, Stakes, Finland

    Antti Malmivaara

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van Tulder, M., Koes, B., Seitsalo, S. et al. Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review. Eur Spine J 15 (Suppl 1), S82–S92 (2006). https://doi.org/10.1007/s00586-005-1049-5

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