Surgical or Nonoperative Treatment for Lumbar Spinal Stenosis?

作者：Antti Malmivaara, P Slätis, Markku Heliövaara, Päivi Sainio, Heikki Kinnunen, Jyrki Kankare, Nina Dalin-Hirvonen, Seppo Seitsalo, Arto Herno, P. Kortekangas, Timo Niinimäki, H.S. Rönty, Kaj Tallroth, Veli Turunen, Paul Knekt, Tommi Härkänen, Heikki Hurri · 发表于：Spine · 年份：2007 · DOI：10.1097/01.brs.0000251014.81875.6d · 被引用次数：549 · 研究领域：Spine and Intervertebral Disc Pathology、Scoliosis diagnosis and treatment、Cervical and Thoracic Myelopathy

In Brief Study Design. A randomized controlled trial. Objectives. To assess the effectiveness of decompressive surgery as compared with nonoperative measures in the treatment of patients with lumbar spinal stenosis. Summary of Background Data. No previous randomized trial has assessed the effectiveness of surgery in comparison with conservative treatment for spinal stenosis. Methods. Four university hospitals agreed on the classification of the disease, inclusion and exclusion criteria, radiographic routines, surgical principles, nonoperative treatment options, and follow-up protocols. A total of 94 patients were randomized into a surgical or nonoperative treatment group: 50 and 44 patients, respectively. Surgery comprised undercutting laminectomy of the stenotic segments in 10 patients augmented with transpedicular fusion. The primary outcome was based on assessment of functional disability using the Oswestry Disability Index (scale, 0–100). Data on the intensity of leg and back pain (scales, 0–10), as well as self-reported and measured walking ability were compiled at randomization and at follow-up examinations at 6, 12, and 24 months. Results. Both treatment groups showed improvement during follow-up. At 1 year, the mean difference in favor of surgery was 11.3 in disability (95% confidence interval [CI], 4.3–18.4), 1.7 in leg pain (95% CI, 0.4–3.0), and 2.3(95% CI, 1.1–3.6) in back pain. At the 2-year follow-up, the mean differences were slightly less: 7.8 in disability (9...