Surgical or Nonoperative Treatment for Lumbar Spinal Stenosis?

Malmivaara, Antti; Slätis, P; Heliövaara, Markku; Sainio, Päivi; Kinnunen, Heikki; Kankare, Jyrki; Dalin-Hirvonen, N.; Seitsalo, Seppo; Herno, Arto; Kortekangas, P.; Niinimäki, Tuukka; Rönty, Hannu; Tallroth, Kaj; Turunen, Veli; Knekt, Paul; Härkänen, Tommi; Hurri, Heikki

doi:10.1097/01.brs.0000251014.81875.6d

Cited by 471 publications

(421 citation statements)

References 20 publications

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“…By used covariates, the effect of initial pain, disability and accumulation of fulfilment of self-acting exercises on outcome could be controlled. This study is in line with the earlier literature [23], strengthening the concept that ''treatment as usual'' is sufficient postoperatively in LSS. With increasing life expectancy, the incidence and prevalence of LSS will increase in aging population, meaning increase also in rates of LSS surgery.…”

Section: Limitationssupporting

confidence: 91%

“…In addition, the benefits of physiotherapy in conservative treatment of LSS have been reported [23,42,43]. There was little evidence available concerning the effect of abdominal muscle training in a clinical setting when planning this study [14].…”

Section: The Interventionmentioning

confidence: 99%

“…This kind of quality of physiotherapy and amount of training would be anticipated to improve the outcome, if the intervention were to have had any effect. The outcome measures were relevant, and have been used in surgical studies of LSS [1,23,24,42]. By used covariates, the effect of initial pain, disability and accumulation of fulfilment of self-acting exercises on outcome could be controlled.…”

Section: Limitationsmentioning

confidence: 99%

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Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up

et al. 2011

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Section: Limitationssupporting

confidence: 91%

Section: The Interventionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up

et al. 2011

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“…Although reduced walking distance is an important component of the symptom complex of lumbar stenosis, the assessment of walking distance is relatively insensitive to change. Studies comparing surgery with conservative treatment for lumbar stenosis also found no differences between treatment groups regarding walking distance, although other outcome measures differed significantly between treatment groups [56,57].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

et al. 2015

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Purpose To compare the effectiveness of techniques of posterior decompression that limit the extent of bony decompression or to avoid removal of posterior midline structures of the lumbar spine versus conventional facetpreserving laminectomy for the treatment of patients with degenerative lumbar stenosis. Methods A comprehensive electronic search of the Cochrane Central Register of Controlled Trials, MED-LINE, EMBASE, Web of Science, and the clinical trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform was conducted for relevant literature up to June 2014. Results A total of four high-quality RCTs and six lowquality RCTs met the search criteria of this review. These studies included a total of 733 participants. Three different techniques that avoid removal of posterior midline structures are compared to conventional laminectomy; unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy. Evidence of low or very low quality suggests that different techniques of posterior decompression and conventional laminectomy have similar effects on functional disability and leg pain. Only perceived recovery at final follow-up was better in patients that underwent bilateral laminotomy compared with conventional laminectomy. Unilateral laminotomy for bilateral decompression and bilateral laminotomy resulted in numerically fewer cases of iatrogenic instability, although in both cases, the incidence of instability was low. The difference in severity of postoperative low back pain following bilateral laminotomy and split-spinous process laminotomy was significantly less, but was too small to be clinically important. We found no evidence to show that the incidence of complications, length of the procedure, length of hospital stay and postoperative walking distance differed between techniques of posterior decompression. Conclusion The evidence provided by this systematic review for the effects of unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy compared with conventional laminectomy on functional disability, perceived recovery and leg pain is of low or very low quality. Therefore, further research is necessary to establish whether these techniques provide a safe and effective alternative for conventional laminectomy. Proposed advantages of these techniques regarding the incidence of iatrogenic instability and postoperative back pain are plausible, but definitive conclusions are limited by poor methodology and poor reporting of outcome measures among included studies.

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“…Most implants are used for degenerative spinal diseases, one of which is LSS. The reported successful clinical outcome after bony decompression, the gold standard treatment, is only 64 % and many patients remain to have associated low back pain [5,[7][8][9]. In an effort to improve clinical outcome, a French group introduced a new non-rigid fixation [interspinous process devices (IPDs)] for patients with LSS and associated back pain in 1984: the Wallis system [10][11][12].…”

Section: Interspinous Process Devices Versus Microdecompressionmentioning

confidence: 99%

Minimally invasive surgery for lumbar spinal stenosis

Moojen

Gaag

2016

Eur J Orthop Surg Traumatol

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Recent trends in spine surgery, such as endoscopic and other ''micro'' techniques, promise less invasive procedures with better outcomes compared to conventional open techniques for decompressing nerves. Minimally invasive surgery (MIS), highly promoted by commercial parties for instrumented cases in particular, is popular with patients and physicians [1]. Widespread adoption of these techniques should always be preceded by careful evaluation to ensure safety and determine added value of such so-called surgical innovation [2,3]. Actual and controversial topics concerning MIS for lumbar spinal stenosis (LSS) were recently addressed in high-quality studies: open laminectomy versus microdecompression by Nerland et al. and decompression versus interspinous process implant by our group [4,5]. In some way, the opposite of MIS was addressed in a recent landmark study by Försth et al.; does decompression versus decompression plus instrumented fusion for LSS yield better outcomes [6]? The three studies address very relevant issues of the neurosurgical daily practice and will be discussed hereafter. The authors analyze data from a large, well-maintained and comprehensive national registry in Norway (the Norwegian Registry for Spine Surgery, NORspine). Thirty six out of 40 centers performing lumbar spine surgery in Norway record data prospectively in NORspine, making it a one of the unique national resource for spine research. Nerland and colleagues identified 885 eligible patients (out of 2745 screened) of whom 81 % completed the 1-year follow-up. Open laminectomy versus microdecompressionOpen laminectomy and microdecompression were associated with similar and statistically equivalent improvements in Oswestry disability scores and quality of life (EuroQol EQ-5D) at 1-year follow-up. Furthermore, the techniques did not differ in older people and obese patients in predefined subgroup analyses. The number of patients with complications was higher in the open laminectomy group (15.0 vs. 9.8 %, P = 0.018), but this difference did not hold after propensity matching (P = 0.23). Patients in the microdecompression group had shorter hospital stays, both for single-level decompression (difference 1.5 days, 95 % confidence interval 1.7-2.6, P \ 0.001) and two-level decompression (0.8 days, 1.0-2.2, P = 0.003).The authors concluded that microdecompression is the treatment of choice for patients with stenosis of the lumbar spine for the technique shows good clinical results, equal to open laminectomy at 1-year follow-up. Theoretically,

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Surgical or Nonoperative Treatment for Lumbar Spinal Stenosis?

Cited by 471 publications

References 20 publications

Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up

Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

Minimally invasive surgery for lumbar spinal stenosis

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