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Surgery for Spinal Stenosis Provides Better Outcome

Lumbar spinal stenosis is the most common reason for spinal surgery in patients, but its effectiveness compared with nonsurgical treatment methods has never been explored until now. Researchers at Dartmouth Medical School, and colleagues, reported in the Feb. 21 issue of the New England Journal of Medicine that patients treated with surgical decompression for severe lumbar spinal stenosis saw significantly more improvement than patients treated nonsurgically.
The study consisted of a randomized group of patients given surgery or nonsurgical care and an observational cohort of patients who declined randomization. However, there were incidents of frequent crossovers in both directions in the randomized and observational groups and was therefore not definitive, the researchers said.
Treatment consisted of either posterior decompressive laminectomy or usual nonsurgical care, including active physical therapy, education or counseling with home exercise instruction, and nonsteroidal anti-inflammatory drugs if tolerated.
The primary outcomes were measures of bodily pain and physical function on the Medical Outcomes Study 36-item Short-Form General Health Survey and the modified Oswestry Disability Index at six weeks, three months, six months, and one and two years.
Surgical patients experienced a decrease in pain and improved function as early as six weeks, reached a maximum at six months, and persisted for two years, but those treated nonsurgically improved only moderately.

Source: New England Journal of Medicine

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