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Surgical, nonsurgical spinal stenosis treatments equal over long term

Patients initially treated with surgery reported greater improvements in symptoms and function at all follow-up points.

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Initial surgical treatment of patients with spinal stenosis yields better functional outcomes and less pain than initial nonsurgical management, according to a study by researchers in Boston.

“However, the relative magnitude of the benefit diminished over time such that the relative differences for low back pain and satisfaction were no longer significant over long-term follow-up,” the study authors said.

Yuchiao Chang, PhD, and colleagues at the Massachusetts General Hospital, conducted a prospective, observational study that included 144 patients with lumbar spinal stenosis treated at community-based specialty practices throughout Maine. In the study, 77 patients initially underwent surgery and the remaining 67 patients received nonsurgical management.

The researchers obtained data at baseline and at regular intervals over 10 years follow-up using mailed questionnaires, which recorded patient-reported symptoms, including back and leg pain, back function and satisfaction, according to the study.

The researchers found a 10-year survival rate of 69%. During follow-up, 23% of patients initially treated with surgery and 38% of patients initially treated nonsurgically underwent subsequent surgical procedures, the authors said.

Patients who underwent initial surgical treatment had worse baseline symptoms and functional status compared to patients initially treated nonsurgically. Surgically treated patients reported greater improvements in symptoms and function at all follow-up points, however. Surgically treated patients also reported greater satisfaction, which indicates better outcomes, the authors said.

“Regardless of initial treatment received, patients undergoing subsequent surgical procedures reported less improvement in outcomes over time than patients who did not undergo subsequent procedures, but the relative differences between treatment groups were similar in analyses that controlled for outcomes after subsequent procedures,” they said.

For more information:

• Chang Y, Singer DE, Wu YA, et. al. The effect of surgical and nonsurgical treatment on longitudinal outcomes of lumbar spinal stenosis over 10 years. J Am Geriatr Soc. 2005;53:785-792.