Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial
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We randomised a total of 94 patients with long-standing moderate lumbar spinal stenosis (LSS) into a surgical group and a non-operative group, with 50 and 44 patients, respectively. The operative treatment comprised undercutting laminectomy of stenotic segments, augmented with transpedicular-instrumented fusion in suspected lumbar instability. The primary outcome was the Oswestry disability index (ODI), and the other main outcomes included assessments of leg and back pain and self-reported walking ability, all based on questionnaire data from 85 patients at the 6-year follow-up. At the 6-year follow-up, the mean difference in ODI in favour of surgery was 9.5 (95% confidence interval 0.9–18.1, P-value for global difference 0.006), whereas the intensity of leg or back pain did not differ between the two treatment groups any longer. Walking ability did not differ between the treatment groups at any time. Decompressive surgery of LSS provided modest but consistent improvement in functional ability, surpassing that obtained after non-operative measures.
KeywordsSpinal stenosis Surgical treatment Non-operative treatment Randomised controlled trial
Supported by the Finnish Office for Health Care Technology Assessment and the participating hospitals.
- 10.Drew B, Bhandari M, Kulkarni AV, Louw D, Reddy K, Dunlop B (2000) Reliability in grading the severity of lumbar spinal stenosis 13:253–258Google Scholar
- 11.Fairbank J, Couper J, Davies J, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 8:271–273Google Scholar
- 13.Jansson K-Å, Németh G, Granath F, Jönsson B, Blomqvist P (2009) Health-related quality of life (EG-5D) before and one year after surgery for lumbar spinal stenosis. J Bone Jt Surg (Br) 91-B:211–216Google Scholar
- 18.Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J, Dalin-Hirvonen N, Seitsalo S, Herno A, Kortekangas P, Niinimaki T, Rönty H, Tallroth K, Turunen V, Knekt P, Härkänen T, Hurri H, Finnish Lumbar Spinal Research Group (2007) Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine 32:1–8PubMedCrossRefGoogle Scholar
- 20.Schönström N, Hansson T (1988) Pressure changes following constriction of the cauda equina Spine 13:385–388Google Scholar
- 22.Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257–2270PubMedCrossRefGoogle Scholar
- 24.Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, Birkmeyer N, Herkowitz H, Longley M, Lenke L, Emery S, Hu SS (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the spine patient outcomes research trial (SPORT) randomized and observational cohorts. J Bone Joint Surg [Am] 91:1295–1304CrossRefGoogle Scholar