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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