Critically appraised paper: Comprehensive non-surgical treatment leads to improved walking ability in people with lumbar spinal stenosis [commentary]

IntroductionSymptomatic lumbar spinal stenosis is the most common indication for spinal surgery. However, more than one-third of the patients undergoing surgery for lumbar stenosis report dissatisfaction with the results. On the other hand, conservative treatment has shown positive results in some cases. This trial will compare the outcomes of surgical versus non-surgical treatment for lumbar stenosis. The study includes a multidimensional follow-up, aiming to study the association between outcome and other studied parameters, mainly electromyography and nerve conduction. Moreover, it may contribute to a better understanding of the pathophysiology of lumbar stenosis and to the development of future pharmacological treatments.Methods and analysisUppSten is a single-centre randomised controlled trial in which 150 patients with symptomatic lumbar spinal stenosis will be randomised into one of two treatment arms. The patients in the surgical arm will undergo laminectomy; the patients in the non-surgical arm will be given a structured physical training programme. The primary outcome of the study will be the Oswestry Disability Index. Secondary outcomes will include motor amplitude and degree of denervation activity obtained by means of nerve conduction studies and electromyography. Patient-reported outcome measures will be also used as secondary outcomes. Blood sample analysis and the investigation of potential inflammation markers are the additional secondary outcome parameters. Laboratory evaluation will include blood sample collection before the treatment initiation and after 6 months. Flavum ligament biopsies will be performed in the surgical group. Finally, tertiary outcomes will include neurophysiological measures, the objective walking ability and radiological evaluation.Ethics and disseminationThe study is approved by the Local Ethics Committee (Dnr 2017–506), the Hospital’s Clinical Trials Committee (2018–0001) and the National Biobank Council and Uppsala Biobank (BbA-827-2018-025). The results will be presented in peer-reviewed journals and at international conferences.Trial registration numberNCT03495661

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Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial

Chiropractic & Manual Therapies ◽

10.1186/2045-709x-22-19 ◽

2014 ◽

Vol 22 (1) ◽

Cited By ~ 9

Author(s):

Michael Schneider ◽

Carlo Ammendolia ◽

Donald Murphy ◽

Ronald Glick ◽

Sara Piva ◽

...

Keyword(s):

Older Adults ◽

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Treatment Methods ◽

Randomized Controlled ◽

Walking Capacity ◽

Lumbar Spinal ◽

Objective Outcome ◽

Non Surgical Treatment

Abstract Background Lumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis. Methods/design This study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome. Discussion Our study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms. Trial registration ClinicalTrials.gov identifier: NCT01943435

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Surgical versus non-surgical treatment for lumbar spinal stenosis

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd010264.pub2 ◽

2016 ◽

Cited By ~ 34

Author(s):

Fabio Zaina ◽

Christy Tomkins-Lane ◽

Eugene Carragee ◽

Stefano Negrini

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Spinal ◽

Non Surgical Treatment

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Correlation of Patient Satisfaction with Symptom Severity and Walking Ability after Surgical Treatment for Degenerative Lumbar Spinal Stenosis

Spine ◽

10.1097/01.brs.0000090888.63860.4f ◽

2003 ◽

Vol 28 (21) ◽

pp. 2477-2481 ◽

Cited By ~ 50

Author(s):

Kazuo Yamashita ◽

Junzo Hayashi ◽

Kenji Ohzono ◽

Kazuo Hiroshima

Keyword(s):

Patient Satisfaction ◽

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Symptom Severity ◽

Walking Ability ◽

Degenerative Lumbar Spinal Stenosis ◽

Lumbar Spinal

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Recent Domestic and International Trends on Non-Surgical Treatment of Lumbar Spinal Stenosis

Journal of Korean Medicine Rehabilitation ◽

10.18325/jkmr.2021.31.3.1 ◽

2021 ◽

Vol 31 (3) ◽

pp. 1-17

Author(s):

Mi-Hyun Kim ◽

K.M.D. ◽

Eun-Sang Park ◽

Hyeon-Ho Hwang ◽

Yeo-Gyeong Lee ◽

...

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

International Trends ◽

Lumbar Spinal ◽

Non Surgical Treatment

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Prediction of walking ability following posterior decompression for lumbar spinal stenosis

European Spine Journal ◽

10.1007/s00586-021-06938-6 ◽

2021 ◽

Author(s):

Suzanne McIlroy ◽

Feroz Jadhakhan ◽

David Bell ◽

Alison Rushton

Keyword(s):

Quality Of Life ◽

Higher Education ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Walking Distance ◽

Walking Ability ◽

Poor Outcome ◽

Lumbar Spinal ◽

Reduced Risk

Abstract Purpose Following surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS. Methods An observational cohort study was conducted using data from the British Spine Registry (2017–2018) of adults (≥ 50 years) with LSS, who underwent ≤ 2 level posterior lumbar decompression. Patients receiving fixation or who had previous lumbar surgery were excluded. Walking ability was assessed by a single item on the Oswestry Disability Index and dichotomised into poor/good outcome. Multivariable regression models were performed. Results 14,485 patients were identified. Pre-operatively 30% patients reported poor walking ability, this decreased to 8% at 12 months follow-up. Predictors associated with poor walking ability at 12 months were: increasing age (≥ 75 years OR 1.54, 95% CI 1.07, 2.18), BMI ≥ 35 kg/m2 (OR 1.52, 95% CI 1.00, 2.30), severity of leg pain (OR 1.10, CI 95% 1.01, 1.21), disability (OR 1.01, 95% CI 1.01, 1.02) and quality of life (OR 0.72, 95% CI 0.56, 0.89). Pre-operative maximum walking distance (OR 1.10, 95% CI 1.05, 1.25) and higher education (OR 0.90, 95% CI 0.80, 0.96) were associated with reduced risk of poor walking ability at 12 months; p < 0.05. Depression, fear of movement and symptom duration were not associated with risk of poor outcome. Conclusion Older age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.

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