Spinal Surgery Provides Higher Incidence of Relief for Spinal Stenosis
Lumbar spinal stenosis, a common condition among older people, can cause significant deterioration in quality of life. Currently there is no gold standard for treatment to relieve the pain caused by the stenosis. Some patients are treated surgically, especially if their symptoms are severe; others are managed conservatively with physiotherapy, medication, and education.
Earlier studies done to investigate the best treatment for spinal stenosis have not been conclusive. For example, one small study of 22 patients found that surgery was better at relieving pain and symptoms than was non-surgical treatment, and yet another study of 47 patients found only fair results in both surgery and non-surgery groups, with a small advantage to those who didn't have surgery.
The authors of this prospective, non-randomized study said that previous studies didn't address two important questions: "Is surgery or non-surgical treatment a better option for patients with...lumbar stenosis?" and "What proportion of these patients get better, worse, or remain the same with time?"
One hundred twenty five patients with persistent back pain that radiated down one or both legs participated in this study. One hundred twelve completed all requirements and were included in the results. The patients chose to either undergo surgery or to receive non-surgical treatment. Those who underwent surgery had one of two procedures: decompression or decompression with fusion. The non-surgical interventions included back bracing; epidural steroids (medication injected directly into the spinal cord); medications such as analgesics (pain medications), anti-inflammatory drugs, and muscle relaxants; spinal manipulation; and weight loss, if necessary.
Before receiving treatment, the patients were evaluated by the researchers who were using a questionnaire called the Roland-Morris questionnaire. The patients were followed for two years and the patients who didn't undergo surgery were treated by their family doctors, although they were still followed by a spinal surgeon.
At the two-year follow-up, and using the same questionnaire to evaluate the patients, the researchers found that the patients who had decompression surgery or decompression surgery and fusion improved more (63.3 percent and 61.5 percent, respectively) than did the non-surgical group (25 percent). Four percent of the patients in the decompression-only group got worse, as did 12.5 percent of patients who had the other surgery. The majority of the patients who did not have surgery appeared to remain at the same level as prior to the surgery (62.5 percent). In the two surgical groups, 32.7 percent of the patients who had decompression only and 35.9 percent of the other group remained about the same as before the surgery.
Findings also showed that the patients who had surgery may experience residual symptoms and that they should be prepared for this to occur.
The authors did point out that there are some weaknesses in the study, including the group choices. They said that it could be that those patients who had the most to improve, the ones with the most symptoms, appear to be the ones who chose surgery.
The authors concluded that, although surgery can improve the quality of life in patients with spinal stenosis, they could still have residual symptoms that they should be aware of in order to prepare effectively.
Aravine Athivaraham, MD, and David Yen, MD, FRCS(C). Is Spinal Stenosis Better Treated Surgically or Nonsurgically? In Clinical Orthopaedics and Related Research. May 2007. Vol. 458. Pp. 90-93.