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Surgical or Nonoperative Treatment for Lumbar Spinal Stenosis? A Randomized Controlled Trial
Malmivaara et. al. Spine Volume 32, Number 1, pp1-8
In this study from Finland, 94 patients with lumbar spinal stenosis were randomly assigned to either surgical treatment or nonoperative treatment. All patients had symptoms of back pain radiating into the legs with fatigue and numbness worsened by walking. This group of patient’s symptoms were felt to fall in a middle range where either surgical or nonsurgical treatment could reasonably be considered.
Surgical treatment consisted of laminectomy in all cases with a small
percentage also requiring a fusion for spondylolisthesis. Nonoperative
care consisted of physical therapy and antinflamatory medicines, and
patient education.
Both groups showed improvement during the follow-up period, but
patients treated surgically reported significantly greater improvement
in leg pain, back pain, and overall disability. The outcomes of
surgery remained superior through the two year follow-up period.
Dr Nelson comments:
This is a very interesting study that compares the results of surgical
to nonsurgical care in a group of patients with lumbar spinal stenosis
with “middle of the road” or moderate symptoms that could realistically
be treated surgically or nonsurgically. (More extreme cases were not
included in this study).
It is a well designed study where patients were randomly assigned
to treatment groups to eliminate selection bias, and sufficient patient
numbers allow for meaningful conclusions.
Both surgical and nonsurgical patients improved during the 2 years
of the study. However, patients receiving surgical treatment in the
form of laminectomy experienced significantly better improvements in
leg and back pain, and overall disability as compared to the
nonsurgical group. Superior results in the surgical group remained
statistically significant throughout the follow-up period, but the
differences diminished over time.
These results are in line with what I have observed in my own
patients. Moderate lumbar spinal stenosis can be successfully treated
either surgically or nonsurgically. My general impression, however,
has been that the surgically treated patients experience a greater
degeree of pain relief and increased function as compared to
nonsurgically treated patients. The advantages of surgery also need to
be weighed against the risks of surgery, and the increased investment
of resources and time associated with surgery. These are important
discussions and decisions that are best made only after a thorough
doctor consultation and usually discussion with trusted family and
friends.
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