Surgical versus non-surgical treatment for lumbar spinal stenosis

Zaina, Fabio; Tomkins-Lane, Christy; Carragee, Eugene J.; Négrini, Stefano

doi:10.1002/14651858.cd010264.pub2

Cited by 205 publications

(178 citation statements)

References 55 publications

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“…Despite some evidence that in the long-term surgery presents the same outcomes of the conservative strategy [7, 24], our results confirm the majority of previous reports [4–9]: in the long run, patients who undergo surgery preserve better neurological and functional status in respect to non-operated patients.…”

Section: Discussionsupporting

confidence: 80%

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up

Caruso

Pesce²,

Martines

et al. 2018

J Orthop Traumatol

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BackgroundThe degenerative lumbar spinal stenosis is one of the most commonly treated spinal disorders in older adults; despite its increasing frequency, it is not yet clear what the most effective therapy might be. The aim of this study is to investigate the very long term results of a homogenized cohort of patients suffering from lumbar spinal stenosis: the first subset of patients operated on with laminectomy and the second subset of patients was also advised to undergo laminectomy but never operated on.MethodsPatients from both subgroups were advised to undergo surgery, according to the same criteria, in the period between 2000 and 2010 and were re-evaluated in the period between January and December 2016.ResultsComparing the two subsets of patients, both suffering from clinically relevant LSS, the first subset returns a statistically significant clinical improvement at follow-up. The rate of excellent results decreases over years. Iatrogenic spinal instability incidence was found to be 3.8% in the present cohort.ConclusionsAlthough the improvement of the first postoperative years decreases over time and despite the lack of general consensus, the lack of established shared guidelines and the limitations of this research, the results support the utilisation of surgery for the management of this condition.Level of Evidence3.

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Section: Discussionsupporting

confidence: 80%

Assessing the real benefits of surgery for degenerative lumbar spinal stenosis without instability and spondylolisthesis: a single surgeon experience with a mean 8-year follow-up

Caruso

Pesce²,

Martines

et al. 2018

J Orthop Traumatol

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“…Longer term follow-up data were available but a combined analysis could not be performed for those end points. 127 A recent trial, published since these reviews, compared surgical decompression with a standardized is often driven by surgeons' preferences and enthusiasm rather than patient characteristics. 8 In addition, there is no evidence of benefit for fusion in LSS without spondylolisthesis or scoliosis.…”

Section: Injectionsmentioning

confidence: 99%

Management of lumbar spinal stenosis

Lurie¹,

Tomkins-Lane

2016

BMJ

Self Cite

409

310

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Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.

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“…Therefore, in patients with severe LSS who have been recommended to undergo surgery based on radiological signs (though they may not have absolute indications for surgery), traditional Korean medical treatment may be recommended before surgery. Furthermore, as noted in a recent Cochrane review [35], it is difficult to say if surgery is superior to conservative therapy in LSS treatment. Thus, traditional Korean medicine can be a viable alternative treatment for LSS.…”

Section: Discussionmentioning

confidence: 99%