Authors’ conclusions:
We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment. No clear benefits were observed with surgery versus non-surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects. High-quality research is needed to compare surgical versus conservative care for individuals with lumbar spinal stenosis.
Review question: We reviewed the evidence that compares surgery versus non-surgical treatment for a condition called lumbar spinal stenosis. This condition occurs when the area surrounding the spinal cord and nerves becomes smaller.
Background: People with lumbar spinal stenosis experience a range of symptoms including back pain, leg pain, numbness and tingling in the legs and reduced physical function. These symptoms prompt people to seek treatment. One option for treatment is surgery. Other treatment options include physical therapy, exercise, braces and injections into the spine.
Study characteristics: We included five studies that compared surgical versus non-surgical treatment in a total of 643 people with lumbar spinal stenosis. Average age of participants in all studies was over 59 years. Follow-up periods ranged from six weeks to 10 years.
Key results: We cannot conclude on the basis of this review whether surgical or non-surgical treatment is better for individuals with lumbar spinal stenosis. Nevertheless, we can report on the high rate of effects reported in three of five surgical groups, ranging from 10% to 24%. No side effects were reported for any of the conservative treatment options.
Three studies compared spine surgery versus various types of non-surgical treatment. It is difficult for review authors to draw conclusions from these studies because non-surgical treatments were inadequately described. One study that compared surgery versus bracing and exercise found no differences in pain. Another study compared surgery versus spinal injections and found better physical function with injections, and better pain relief with surgery at six weeks. Still another trialcompared surgery with an implanted device versus non-surgical care. This studyreported favourable outcomes of surgery for symptoms and physical function.
Quality of the evidence: Evidence obtained by comparing surgery versus non-surgical treatment is of low quality. Well-designed studies are needed to examine this problem. In particular, researchers need to do a better job of describing the details of non-surgical treatments.
We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment. No clear benefits were observed with surgery versus non-surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects. High-quality research is needed to compare surgical versus conservative care for individuals with lumbar spinal stenosis..