Surgery versus nonsurgery for lumbar spinal stenosis: an in-depth analysis of the 2016 Cochrane analysis, the studies included for analysis, and Cochrane methodology

Lumbar spinal stenosis is a common degenerative condition among the elderly population and a leading cause of morbidity in this age group. A recent Cochrane analysis reviewed the evidence for surgical versus nonsurgical treatment from 5 prospective, randomized controlled studies and concluded that "No clear benefits were observed with surgery versus non-surgical treatment." This is despite the fact that all 5 of the reports analyzed concluded that surgery provided superior outcome compared to nonsurgical therapy. This report analyzes, in detail, the Cochrane analysis of Zaina et al., each of the 5 studies included in the Zaina analysis, and the Cochrane methodology itself. Unlike the ultimate in objectivity sought after by the creators of the Cochrane tool, what is revealed is a remarkably subjective methodology fraught with the potential for bias.