Extract
Question: In patients with lumbar spinal stenosis, what is the
effectiveness of decompressive surgery compared with nonoperative treatment
with respect to pain and disability?Design: Randomized (allocation
concealed)*, unblinded,
controlled trial with 24-month follow-up.*Information provided by authorSetting: 4 university hospitals in Finland.Patients: 94 patients (mean age, 63 y; 67% women) with lumbar spinal
stenosis. Inclusion criteria were back pain radiating to lower limbs or
buttocks, fatigue or loss of sensation in the lower limbs aggravated by
walking, persistent pain without progressive neurologic dysfunction, spinal
canal narrowing on imaging, and symptoms and signs lasting for >6 months.
Exclusion criteria were lumbar spinal stenosis severe enough to require
surgery or mild enough to exclude surgery; spinal stenosis not caused by
degeneration; spondylolysis and spondylolytic spondylolisthesis; a previous
back operation because of stenosis or instability; a herniated lumbar disc in
the previous 12 months; another spinal disorder; intermittent claudication due
to atherosclerosis; severe osteoarthritis, arthritis, or neurologic disease
affecting the lower limbs; psychiatric disorders; or alcoholism. 87 patients
(93%) were available for 24-month
follow-up.