Danish national clinical guidelines for surgical and nonsurgical treatment of patients with lumbar spinal stenosis

Rousing, Rikke; Jensen, Rikke Krüger; Fruensgaard, Søren; Strøm, Janni; Brøgger, Helle Algren; Degn, Jørgen Dan Møller; Andersen, Mikkel

doi:10.1007/s00586-019-05987-2

Cited by 40 publications

(55 citation statements)

References 25 publications

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“…The North American Spine Society (NASS) clinical practice guidelines 74 found insufficient evidence to recommend for or against the use of pharmacological or non-pharmacological treatments, while the Danish Health Authority (DHA) guideline 114 recommended against paracetamol, non-steroidal antiinflammatory drugs (NSAIDs), opioids, neurogenic pain medication, muscle relaxants or manual therapy to treat these patients. The two guidelines currently available need to be updated because their recommendations were informed by evidence published more than 10 (NASS) 74 and 4 (DHA) 114 years ago respectively. Considering the substantial lack of high-quality evidence for the effectiveness of the interventions addressed in these guidelines, new trials are likely to impact the recommendations.…”

Section: Introductionmentioning

confidence: 99%

Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline

Bussières¹,

Cancelliere²,

Ammendolia³

et al. 2021

The Journal of Pain

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Section: Introductionmentioning

confidence: 99%

Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline

Bussières¹,

Cancelliere²,

Ammendolia³

et al. 2021

The Journal of Pain

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“…LSS surgery can be divided into lumbar laminectomy and decompression, pedicle screw internal fixation and bone graft fusion. [ 5 – 9 ] The aim of this study was to perform a meta-analysis of all available literature to obtain updated evidence about the efficacy of decompression with fusion versus decompression in the treatment of LSS.…”

Section: Introductionmentioning

confidence: 99%

Decompression with fusion versus decompression in the treatment of lumbar spinal stenosis

Chen

Wang

et al. 2020

Medicine

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Objective: The goal of this study was to review relevant studies in order to determine the efficacy of decompression with fusion versus decompression in the treatment of lumbar spinal stenosis. Methods: Using appropriate keywords, we identified relevant studies using PubMed, the Cochrane library, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through October 2019 were considered for inclusion. For each study, we used odds ratios, mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes. Results: We found 13 studies that were consistent with this meta-analysis with a total of 29066 patients. Compared with decompression, decompression with fusion significantly increased the incidence of complications (RR: 1.41, 95%CI: 1.26–1.57), the length of hospital stay (WMD: 1.868, 95%CI: 1.394–2.343), operative time (WMD: 80.399, 95%CI: 44.397–116.401), estimated blood loss (WMD: 309.356, 95%CI: 98.008–520.704) and Zurich claudication questionnaire in symptom severity (WMD: 0.200, 95%CI: 0.006–0.394). The reoperation rate was lower in the decompression with fusion group than the decompression group but without significant difference (RR: 0.91, 95%CI: 0.82–1.00). There was no significant difference between 2 groups in visual analog scale (leg pain and back pain), ODI, Short Form 36 Health Survey physical component summary, Short Form 36 Health Survey mental component summary, and Zurich claudication questionnaire physical function. Conclusion: Decompression with fusion has no significant clinical advantages in treatment of lumbar spinal stenosis when compared with decompression.

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“…These also included the presence of LBP although this symptom is not expected to be specific for LSS and is not part of the description of the disease guidelines. 26,27 Rather than choosing a limited number of questions, we included a broad spectrum excluding only overlapping questions, questions not related to LSS or clinical examination findings. The questionable role of LBP as an indicator is actually corroborated by our study, with LBP being the only item with an OR less than one.…”

Section: Discussionmentioning

confidence: 99%

<p>Diagnostic Screening for Lumbar Spinal Stenosis</p>

Jensen

Lauridsen

Andresen

et al. 2020

CLEP

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Purpose: To develop a self-administered diagnostic screening questionnaire for lumbar spinal stenosis (LSS) consisting of items with high content validity and to investigate the diagnostic value of the questionnaire and the items. Patients and Methods: A self-reported diagnostic LSS screening questionnaire was developed based on items from the existing literature describing key symptoms of LSS. The screening questionnaire (index test) was to be tested in a cohort of patients with persistent lumbar and/or leg pain recruited from a Danish publicly funded outpatient secondary care spine clinic with clinicians performing the reference test. However, to avoid unnecessary collection of data if the screening questionnaire proved to be of limited value, a case-control design was incorporated into the cohort design including an interim analysis. Additional cases for the case-control study were recruited at two Danish publicly funded spine surgery departments. Prevalence, sensitivity, specificity and diagnostic odds ratio (OR) were calculated for each individual item, and AUC (area under the curve) was calculated to examine the performance of the full questionnaire. Results: A 13-item Danish questionnaire was developed and tested in 153 cases and 230 controls. The interim analysis was not in favour of continuing the cohort study, and therefore, only results from the case-control study are reported. There was a positive association for all items except the presence of back pain. However, the association was only moderate with ORs up to 3.3. When testing the performance of the whole questionnaire, an AUC of 0.72 was reached with a specificity of 20% for a fixed sensitivity of 95%. Conclusion: The items were associated with LSS and therefore have some potential to identify LSS patients. However, the association was not strong enough to provide sufficient accuracy for a diagnostic tool. Additional dimensions of symptoms of LSS need identification to obtain a reliable questionnaire for screening purposes.

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Danish national clinical guidelines for surgical and nonsurgical treatment of patients with lumbar spinal stenosis

Cited by 40 publications

References 25 publications

Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline

Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline

Decompression with fusion versus decompression in the treatment of lumbar spinal stenosis

<p>Diagnostic Screening for Lumbar Spinal Stenosis</p>

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