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Systematic review of observational studies reveals no association between low back pain and lumbar spondylolysis with or without isthmic spondylolisthesis

PainSci » bibliography » Andrade et al 2015
updated
Tags: etiology, counter-intuitive, back pain, biomechanics, pro, pain problems, spine

Three articles on PainSci cite Andrade 2015: 1. The Complete Guide to Trigger Points & Myofascial Pain2. The Complete Guide to Low Back Pain3. Nerve Pain Is Overdiagnosed

PainSci notes on Andrade 2015:

It is widely believed that spondylolysis (SL) and/or isthmic spondylolisthesis (IS) cause low back pain. If so, individuals with these conditions should be more prone to back pain (duh). This paper reviewed other studies looking for that association. They found 15 adequate studies. None of them detected an association between SL/IS and LBP. The authors speculate that the two apparent benefits of treatments may just be “due to benign natural history and nonspecific treatment effects.” They suggest that “traditional surgical practice … should be reconsidered.”

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

PURPOSE: The hypothesis that spondylolysis (SL) and/or isthmic spondylolisthesis (IS) cause low back pain (LBP) is widely accepted representing surgical indication in symptomatic cases. If SL/IS cause LBP, individuals with these conditions should be more prone to LBP than those without SL/IS. Therefore, the goal of the study was to assess whether the published primary data demonstrate an association between SL/IS and LBP in the general adult population.

METHODS: Systematic review of published observational studies to identify any association between SL/IS and LBP in adults. The methodological quality of the cohort and case-control studies was evaluated using the Newcastle-Ottawa scale.

RESULTS: Fifteen studies met inclusion criteria (one cohort, seven case-control, seven cross-sectional). Neither the cohort study nor the two highest-quality case-control studies detected an association between SL/IS and LBP; the same is true for the remaining studies.

CONCLUSIONS: There is no strong or consistent association between SL/IS and LBP in epidemiological studies of the general adult population that would support a hypothesis of causation. It is possible that SL/IS coexist with LBP, and observed effects of surgery and other treatment modalities are primarily due to benign natural history and nonspecific treatment effects. We conclude that traditional surgical practice for the adult general population, in which SL/IS is assumed to be the cause of non-radicular LBP whenever the two coexist, should be reconsidered in light of epidemiological data accumulated in recent decades.

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