A prospective study of non-surgical versus surgical treatment for lumbar spinal stenosis without instability. (October 2020)

• Record Type: Journal Article
• Authors: Jung, Jong-myung; Hyun, Seung-Jae; Kim, Ki-Jeong; Kim, Chi Heon; Chung, Chun Kee; Kim, Kyung Hyun; Cho, Yong Eun; Shin, Dong Ah; Park, Youn-Kwan; Choi, Yunhee
• Is Part Of: Journal of clinical neuroscience. Volume 80(2020)
• Page Start: 100
• Page End: 107
• Publication Date: 2020-10
• Subjects: Lumbar spinal stenosis -- Randomized cohort -- Observational cohort -- Non-surgical treatment -- Surgical treatment -- As treated -- Outcomes; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.07.062
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: It is inconclusive which of treatment to lumbar spinal stenosis (LSS) is better. Not all symptomatic LSS patients with surgical indications undergo surgery. We performed a RCT in LSS patients who were surgical candidates. At 12 months, the non-surgical treatment group had less improvements in back pain. Quality of life index showed less improvement in the non-surgical treatment group. Abstract: Objective: Even if analyzed through meta-analyses or systemic reviews ensued lately, we could say that at least it is inconclusive which of the surgical or non-surgical treatment to lumbar spinal stenosis is better particularly in short to intermediate-term. This study compared non-surgical and surgical outcomes in surgical candidates for lumbar spinal stenosis (LSS). Methods: Surgical candidates for LSS were prospectively screened. Patients were offered the option to be enrolled in a randomized cohort, an observational cohort, or not to participate. Patient-reported outcomes were evaluated at baseline, and at 1, 3, 6, and 12 months. The primary outcomes were measures of pain and functional outcomes such as the Korean version of the Oswestry Disability Index (K-ODI), the EuroQol 5-Dimension instrument (EQ-5D), and 36-Item Short-Form Health Survey (SF-36). Results: One hundred and ten patients were enrolled in the randomized cohort and 37 patients in the observational cohort. Among them, 97 patients received non-surgical treatment, and 50 patients underwent surgical treatment. At 12 months, the non-surgical treatment group had less improvements in the primary outcome measures of back pain (mean change: non-surgery, 2.34 vs. surgery, 3.99), leg pain (2.92 vs. 3.40), K-ODI (5.12 vs. 8.31), EQ-5D utility index (0.19 vs. 0.25), and EQ-5D VAS (9.68 vs. 16.0). Most SF-36 section parameters also showed less improvement in the non-surgical treatment group than in the surgical treatment group throughout the 12-month follow-up. Conclusions: In LSS patients without instability, non-surgical treatment resulted in less pain improvement and functional recovery through 1 year.