REVIEW
Introdução: Esta meta-análise avalia a efetividade comparativa das intervenções cirúrgicas e não cirúrgicas no tratamento da estenose lombar do canal vertebral, uma condição degenerativa caracterizada pelo estreitamento do canal espinhal, levando à compressão neural, dor e limitação funcional. Objetivo: resumir a evidência disponível visando determinar se alguma estratégia terapêutica demonstra superioridade. Metodologia: revisão sistemática segundo as diretrizes da Colaboração Cochrane e do PRISMA. Foram incluídos estudos comparativos que avaliaram o tratamento cirúrgico versus conservador em adultos com sintomas radiculares. Revisões, relatos de caso e publicações não disponíveis em língua inglesa foram excluídos. Os desfechos analisados incluíram o Oswestry Disability Index, o Short Form-36 e o Questionário de Incapacidade de Roland–Morris. As análises estatísticas foram conduzidas no RStudio, utilizando modelos de efeitos aleatórios. Resultados: nove estudos, 685 pacientes, atenderam aos critérios de inclusão. A análise agrupada demonstrou redução estatisticamente significativa nos escores do ODI a favor do tratamento cirúrgico, indicando melhor recuperação funcional. Os escores do SF-36 e do Roland–Morris foram inconsistentes ou não significativos entre os grupos, influenciados pela heterogeneidade e variabilidade metodológica. Conclusão: A cirurgia mostrou-se superior na melhora funcional; contudo, os resultados de qualidade de vida foram heterogêneos, reforçando a necessidade de decisões terapêuticas individualizadas.
Introduction: This meta-analysis evaluates the comparative effectiveness of surgical versus nonsurgical interventions for spinal stenosis, a degenerative condition characterized by narrowing of the spinal canal, resulting in neural compression, pain, and functional limitation. Objective: to synthesize available evidence to determine whether one therapeutic strategy demonstrates superiority. Methodology: A systematic review was conducted in accordance with Cochrane Collaboration methods and PRISMA guidelines. Comparative studies evaluating surgical and conservative management in adults with radicular symptoms were included, while reviews, case reports, and non-English publications were excluded. Extracted outcomes included the Oswestry Disability Index, Short Form-36, and Roland–Morris Disability Questionnaire. Results: Nine eligible studies comprising 685 patients met the inclusion criteria. Pooled analysis demonstrated a statistically significant reduction in ODI scores favoring surgical treatment, indicating greater functional improvement. In contrast, SF-36 and Roland–Morris outcomes showed inconsistent or non-significant differences between treatment groups, largely due to substantial heterogeneity and variability in study quality. Most studies presented moderate to serious risk of bias, primarily related to confounding and nonrandomized designs. Conclusion: Surgical intervention was associated with superior functional outcomes compared with conservative treatment, although quality-of-life measures yielded heterogeneous results. Treatment decisions should be individualized based on clinical severity, functional impairment, and patient preferences.
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1Department of Medical Sciences, Universidade Federal da Paraiba, João Pessoa, PB, Brazil.
2Department of Medicine, Universidade Federal Fluminense, RJ, Brazil.
3Faculty of Medicine, Universidade de São Paulo, SP, Brazil.
4Department of Medicine, Universidade Federal de Minas Gerais, MG, Brazil.
5Department of Neurosurgery, Hospital de Clínicas, Universidade de São Paulo, SP, Brazil.
6Faculty of Medicine, Universidade de Pernambuco, Recife, PE, Brazil.
Received Dec 15, 2025
Corrected Jan 18, 2026
Accepted Feb 13, 2026
