Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the spine patient outcomes research trial

James Neil Weinstein, Tor D. Tosteson, Jon D. Lurie, Anna Tosteson, Emily Blood, Harry Herkowitz, Frank Cammisa, Todd Albert, Scott D. Boden, Alan Hilibrand, Harley Goldberg, Sigurd Berven, Howard An

Research output: Contribution to journalArticlepeer-review

342 Scopus citations

Abstract

Study Design.: Randomized trial and concurrent observational cohort study. Objective.: To compare 4 year outcomes of surgery to nonoperative care for spinal stenosis. Summary of Background Data.: Surgery for spinal stenosis has been shown to be more effective compared to nonoperative treatment over 2 years, but longer-term data have not been analyzed. Methods.: Surgical candidates from 13 centers in 11 US states with at least 12 weeks of symptoms and confirmatory imaging were enrolled in a randomized cohort (RC) or observational cohort (OC). Treatment was standard decompressive laminectomy or standard nonoperative care. Primary outcomes were SF-36 bodily pain (BP) and physical function scales and the modified Oswestry Disability index assessed at 6 weeks, 3 months, 6 months, and yearly up to 4 years. Results.: A total of 289 patients enrolled in the RC and 365 patients enrolled in the OC. An as-treated analysis combining the RC and OC and adjusting for potential confounders found that the clinically significant advantages for surgery previously reported were maintained through 4 years, with treatment effects (defined as mean change in surgery group minus mean change in nonoperative group) for bodily pain 12.6 (95% confidence interval [CI], 8.5-16.7); physical function 8.6 (95% CI, 4.6-12.6); and Oswestry Disability index -9.4 (95% CI, -12.6 to -6.2). Early advantages for surgical treatment for secondary measures such as bothersomeness, satisfaction with symptoms, and self-rated progress were also maintained. Conclusion.: Patients with symptomatic spinal stenosis treated surgically compared to those treated nonoperatively maintain substantially greater improvement in pain and function through 4 years.

Original languageEnglish (US)
Pages (from-to)1329-1338
Number of pages10
JournalSpine
Volume35
Issue number14
DOIs
StatePublished - Jun 15 2010

Keywords

  • Nonoperative
  • Outcomes
  • Randomized trial
  • SPORT
  • Spinal stenosis
  • Surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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