Surgical Versus Nonoperative Treatment for Lumbar Spinal Stenosis Four-Year Results of the Spine Patient Outcomes Research Trial

• Type of Material: Article
• Authors: James N. Weinstein, Dartmouth College; Tor D. Tosteson, Dartmouth College; Jon D. Lurie, Dartmouth College; Anna Tosteson, Dartmouth College; Emily Blood, Dartmouth College; Harry Herkowitz, William H. Beaumont Hospital; Frank Cammisa, Hospital for Joint Diseases; Todd Albert, Thomas Jefferson University; Scott Boden, Emory University; Alan Hilibrand, Thomas Jefferson University; Harley Goldberg, Kaiser Permanente; Sigurd Berven, University of California San Francisco; Howard An, Rush Presbyterian St. Lukes
• Language: English
• Date: 2010-06-15
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2010, Lippincott Williams & Wilkins.
• Final Published Version (URL): http://dx.doi.org/10.1097/BRS.0b013e3181e0f04d
• Title of Journal or Parent Work: Spine -Philadelphia- Hanley and Belfus-
• ISSN: 0887-9869
• Volume: 35
• Issue: 14
• Start Page: 1329
• End Page: 1338
• Grant/Funding Information: The National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01-AR45444) and the Office of Research on Women’s Health, the National Institutes of Health, and the National Institute of Occupational Safety and Health, the Centers for Disease Control and Prevention.
• Keywords: Orthopedics; surgery; Life Sciences & Biomedicine; ARTHRODESIS; NONSURGICAL MANAGEMENT; Neurosciences & Neurology; randomized trial; DECOMPRESSION; SPORT; outcomes; SURGERY; OBSERVATIONAL COHORTS; DISK HERNIATION; Science & Technology; DEGENERATIVE SPONDYLOLISTHESIS; nonoperative; HEALTH SURVEY SF-36; INSTRUMENTATION; Clinical Neurology; spinal stenosis
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Pathology

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.