Surgery for Lumbar Spinal Stenosis: Informed Patient Preferences Should Weigh Heavily

Editorials7 April 2015Surgery for Lumbar Spinal Stenosis: Informed Patient Preferences Should Weigh HeavilyJeffrey N. Katz, MD, MScJeffrey N. Katz, MD, MScFrom Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0360 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Symptomatic lumbar spinal stenosis (LSS) is a frequent source of back and lower-extremity pain in older persons. Patients with symptomatic LSS who experience activity limitation despite treatment with acetaminophen, nonsteroidal anti-inflammatory drugs, physical therapy (PT), and epidural steroid injections are often presented the option of decompressive laminectomy. Several studies have compared outcomes of surgical and nonoperative treatments for LSS, the most recent of which is a randomized trial by Delitto and colleagues (1) in this issue. Although none of these studies by itself provides definitive advice to patients, families, and physicians, when taken together, the evidence leads to sensible therapeutic ...References1. Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis. A randomized trial. Ann Intern Med. 2015;162:465-73. doi:10.7326/M14-1420 LinkGoogle Scholar2. Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the Maine Lumbar Spine Study. Spine (Phila Pa 1976). 2000;25:556-62. [PMID: 10749631] CrossrefMedlineGoogle Scholar3. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the Maine Lumbar Spine Study. Spine (Phila Pa 1976). 2005;30:936-43. [PMID: 15834339] CrossrefMedlineGoogle Scholar4. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, et al; SPORT Investigators. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358:794-810. [PMID: 18287602] doi:10.1056/NEJMoa0707136 CrossrefMedlineGoogle Scholar5. Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2010;35:1329-38. [PMID: 20453723] doi:10.1097/BRS.0b013e3181e0f04d CrossrefMedlineGoogle Scholar6. Lurie JD, Tosteson TD, Tosteson A, Abdu WA, Zhao W, Morgan TS, et al. Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2015;40:63-76. [PMID: 25569524] doi:10.1097/BRS.0000000000000731 CrossrefMedlineGoogle Scholar7. Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J, et al; Finnish Lumbar Spinal Research Group. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine (Phila Pa 1976). 2007;32:1-8. [PMID: 17202885] CrossrefMedlineGoogle Scholar8. Slätis P, Malmivaara A, Heliövaara M, Sainio P, Herno A, Kankare J, et al. Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial. Eur Spine J. 2011;20:1174-81. [PMID: 21240530] doi:10.1007/s00586-010-1652-y CrossrefMedlineGoogle Scholar9. Katz JN, Brophy RH, Chaisson CE, deChaves L, Cole BJ, Dahm DL, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368:1675-84. [PMID: 23506518] doi:10.1056/NEJMoa1301408 CrossrefMedlineGoogle Scholar10. Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010;363:331-42. [PMID: 20660401] doi:10.1056/NEJMoa0907797 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Jeffrey N. Katz, MD, MScAffiliations: From Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Acknowledgment: The author thanks Melissa Goczalk for her editorial assistance.Disclosures: Author has disclosed no conflicts of interest. Form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0360.Corresponding Author: Jeffrey N. Katz, MD, MSc, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, jnkatz@partners.org. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSurgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Anthony Delitto , Sara R. Piva , Charity G. Moore , Julie M. Fritz , Stephen R. Wisniewski , Deborah A. Josbeno , Mark Fye , and William C. Welch Metrics Cited byArthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trialAcupuncture for Patients with Lumbar Spinal Stenosis: A Randomised Pilot Trial 7 April 2015Volume 162, Issue 7 Page: 518-519 Keywords Drug therapy Intent to treat analysis Laminectomy Lower back pain Physical functioning Physiotherapy Spine Sports Stenosis Surgery ePublished: 7 April 2015 Issue Published: 7 April 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...