Surgical versus non-surgical treatment for lumbar spinal stenosis

Cochrane Database of Systematic Reviews, 2016 · DOI: 10.1002/14651858.CD010264.pub2 · Published: January 1, 2016

Simple Explanation

This review examines the effectiveness of surgery versus non-surgical treatments for lumbar spinal stenosis (LSS). LSS is a condition where the spinal cord area narrows, causing symptoms like back and leg pain. Non-surgical treatments include physical therapy, exercise, bracing, and spinal injections. The review analyzes five studies involving 643 participants to determine which approach is better. The review could not definitively conclude whether surgery or non-surgical treatment is superior for LSS. However, it highlighted that surgical groups reported side eﬀects ranging from 10% to 24%, while conservative treatments reported no side eﬀects.

Study Duration

Not specified

Participants

643 participants with lumbar spinal stenosis

Evidence Level

Low-quality evidence from five RCTs

Key Findings

1
Low-quality evidence suggests that decompression and conservative treatment yield similar disability outcomes (Oswestry Disability Index) at three, six, and twelve months.
2
One small study found no significant differences in pain outcomes between decompression surgery and usual conservative care (bracing and exercise) at three months, four years, and ten years.
3
Surgical groups demonstrated high side effect rates ranging from 10% to 24%, while conservative treatment groups showed no complications.

Research Summary

This review analyzed five RCTs (10 references) consisting of 643 participants and comparing diﬀerent surgical procedures and conservative approaches. On the whole, these studies provide conflicting low-quality evidence on the eﬀectiveness of surgery versus conservative treatment for LSS. Study results preclude conclusions regarding whether surgical or non-surgical treatment provides better outcomes for people with LSS.

Practical Implications

Clinical Practice

Clinicians should be cautious when proposing surgery for LSS due to the high rates of side effects and lack of clear superiority over conservative treatments.

Informed Consent

Patients should be properly informed about the risks and benefits of both surgical and non-surgical treatment options, especially regarding potential side effects.

Future Research

High-quality research is needed to compare surgery versus well-defined protocols of non-surgical treatment, including standardized diagnostic criteria and clinical outcomes.

Study Limitations

1
Lack of a standard conservative treatment method across studies.
2
Heterogeneity in outcome tools makes comparison diﬀicult.
3
Overall low quality of evidence due to lack of blinding, participant cross-over, and small sample sizes.

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