Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial

Abstract

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.

Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates

“…51 Despite all the variations in outcome among the different decompressive procedures, minimally invasive laminectomy through tubular retractors seems to result in clinical outcome and reoperation rates comparable to those for other decompressive procedures. [8][9][10][11]25,32,36,40,46,53,54,58,[60][61][62][63][64][65][66] However, the radiographic results suggest that this technique is associated with a lower instability rate than the full-open procedures, probably because of the preservation of posterior elements of the lumbar spine. Results from a cost-utility study showed that tubular retractorguided decompression without fusion in this setting is more cost-effective than conventional decompression and fusion (Table 9).…”

Prediction of long-term clinical outcome in patients with lumbar spinal stenosis

“…The most recent trials have demonstrated that the surgical treatment of LSS provided better results than conservative methods of treatment but the efficacy of surgical treatment slowly declined within a few years of the operation [6][7][8].…”

Viscoelastic Disc Arthroplasty Provides Superior Back and Leg Pain Relief in Patients with Lumbar Disc Degeneration Compared to Anterior Lumbar Interbody Fusion

“…There is consensus that surgical treatment of these patients generally shows good outcomes when all conservative measures have failed. [9][10][11][12] In our bivariate, non-adjusted comparisons, patients with VTDR achieved the minimum clinically relevant change of two points in back and leg pain relief 19% and 28% more frequently than patients with fusion, which was statistically significant and can also be deemed clinically relevant.…”