Quality improvement in the management of degenerative spinal disorders: a systematic review of clinical practice guidelines.

STUDY DESIGN: Systematic review and quality appraisal of clinical practice guidelines. PURPOSE: Degenerative spinal diseases are among the leading causes of disability worldwide, with a rising prevalence and corresponding increase in treatment demand. Despite this burden, there is significant variability and uncertainty in clinical decision-making and outcome assessment. This systematic review provides a comprehensive appraisal of existing clinical practice guidelines for degenerative spinal conditions, aiming to evaluate their methodological quality, reporting standards and clinical applicability. METHODS: The methodology of this systematic review was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). The retrieved guidelines and their recommendations were appraised using the Appraisal of Guidelines for Research and Evaluation Global Rating Scale (AGREE GRS) and AGREE Recommendation Excellence (AGREE REX) instrument. RESULTS: A total of 12,632 unique manuscripts were screened, from which 78 guidelines and 1,641 recommendations were ultimately extracted. Half of the guidelines were published by North American societies and three-quarters of all guidelines were focused on lumbar disorders. Most guidelines focused on surgical indications and techniques or combined diagnostic and therapeutic aspects. The appraisal revealed variability in methodological quality across the included guidelines. CONCLUSIONS: This systematic review identified 78 clinical practice guidelines and 1,641 recommendations on the management of degenerative spinal conditions, demonstrating substantial variability in methodological quality and clinical applicability. Future guideline development should focus on methodological rigour, transparent processes and international collaboration to improve the reliability and clinical utility of guidelines.