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For patients with spinal stenosis, long-term outcomes are comparable with surgery or conservative treatment, according to a study published in the journal Spine. |
While earlier reports suggested an advantage of surgery, the updated analysis finds no significant difference in pain, functioning, of disability at eight years’ follow-up, report Jon D Lurie and colleagues of Dartmouth-Hitchcock Medical Center, USA.
The results—representing the largest and highest-quality study to date—provide new evidence on what patients can expect several years after deciding whether or not to have or not have surgery for spinal stenosis. 
The researchers analysed data from the ‘Spine outcomes research trial’ (SPORT), which is one of the largest clinical trials of surgery for spinal disorders. In SPORT, patients meeting strict criteria for spinal stenosis (or other common spinal diagnoses) were randomly assigned to surgery or nonsurgical treatment (such as physical therapy and medications).
Lurie and colleagues analysed 654 patients with spinal stenosis, treated at 13 US hospitals. Of these, 289 were randomly assigned to surgical or nonsurgical treatment. By eight years’ follow-up, surgery was performed in 70% of patients randomised to surgery as well as 52% of those initially assigned to nonsurgical treatment. The remaining 365 patients, who declined to be randomised, were observed after choosing between the two options. Of these patients, 60% opted for surgery. Of those who initially chose nonsurgical treatment, 27% eventually underwent surgery. Long-term follow-up data were available for more than 50% of patients in both studies. Outcomes were assessed in terms of pain, functioning, and disability.