Surgical or Nonoperative Treatment for Lumbar Spinal Stenosis?: A Randomized Controlled Trial.

Malmivaara, Antti; Slatis, Par; Heliovaara, Markku; Sainio, Paivi; Kinnunen, Heikki; Kankare, Jyrki; Dalin-Hirvonen, Nina; Seitsalo, Seppo; Herno, Arto; Kortekangas, Pirkko; Niinimaki, Timo; Ronty, Hannu; Tallroth, Kaj; Turunen, Veli; Knekt, Paul; Harkanen, Tommi; Hurri, Heikki.

The purpose of this study was to assess the effectiveness of decompressive surgery as compared with nonoperative measures in the treatment of patients with lumbar spinal stenosis.  94 patients were randomized into a surgical or nonoperative treatment group: 50 and 44 patients, respectively. Surgery comprised undercutting laminectomy of the stenotic segments in 10 patients augmented with transpedicular fusion. The primary outcome was based on assessment of functional disability using the Oswestry Disability Index (scale, 0-100). Data on the intensity of leg and back pain (scales, 0-10), as well as self-reported and measured walking ability were compiled at randomization and at follow-up examinations at 6, 12, and 24 months.  The authors conclude that although patients improved over the 2-year follow-up regardless of initial treatment, those undergoing decompressive surgery reported greater improvement regarding leg pain, back pain, and overall disability. The relative benefit of initial surgical treatment diminished over time, but outcomes of surgery remained favorable at 2 years.

Spine.    32(1):1-8, January 1, 2007.

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Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest in terms of disability and 21st in terms of overall burden.
News article posted by: Rachael Lowe

Rachael Lowe is Co-Founder and Executive Director of Physiopedia. A physiotherapist and technology specialist Rachael has been working with Physiopedia since 2008 to create a resource that provides universal access to physiotherapy knowledge as well as a platform for connecting and educating the global physiotherapy profession.

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