What question did this study set out to answer?

To assess the four-year comparative effectiveness of decompressive surgical treatment versus nonoperative management for lumbar degenerative spondylolisthesis with spinal stenosis.

June 1, 2009Journal of Bone and Joint SurgeryOpen Access

Surgical Compared with Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis

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To assess the four-year comparative effectiveness of decompressive surgical treatment versus nonoperative management for lumbar degenerative spondylolisthesis with spinal stenosis.
Enrolled surgical candidates across 13 centers with neurogenic symptoms lasting at least 12 weeks and imaging-confirmed degenerative spondylolisthesis into a randomized cohort (N=304) or concurrent observational cohort (N=303).
Assigned patients to standard decompressive laminectomy (with or without fusion) or usual nonoperative care.
Assessed primary outcomes using SF-36 bodily pain, physical function scores, and the modified Oswestry Disability Index through four years of follow-up.
Substantial treatment crossover occurred in the randomized cohort, with 66% of surgical assignees and 54% of nonoperative assignees receiving surgery by four years, resulting in no significant differences in the intention-to-treat analysis at three or four years.
In an adjusted as-treated analysis combining both cohorts, surgery yielded significant four-year advantages in bodily pain (treatment effect, 15.3; 95% CI, 11.0 to 19.7), physical function (18.9; 95% CI, 14.8 to 23.0), and the Oswestry Disability Index (-14.3; 95% CI, -17.5 to -11.1).
Secondary outcomes, including relief from bothersome back and leg symptoms, overall satisfaction, and self-rated progress, maintained significant advantages for surgical treatment at four years.

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Implication

Randomized trial demonstrates sustained pain relief and functional improvements with surgery for lumbar degenerative spondylolisthesis, indicating long-term benefits over nonoperative care.

Cite This Study

Weinstein et al. (2009) studied this question.

synapsesocial.com/papers/6a007b1e2ff633f36577f744 https://doi.org/10.2106/jbjs.h.00913

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Implication

Randomized trial demonstrates sustained pain relief and functional improvements with surgery for lumbar degenerative spondylolisthesis, indicating long-term benefits over nonoperative care.

Surgical Compared with Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis

Key Points

Discussion

Implication

Cite This Study

Surgical Compared with Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis

Key Points

Discussion

Implication

Cite This Study

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