LUMBAR SPINAL STENOSIS - A MATCHED-PAIR STUDY OF OPERATED AND NONOPERATED PATIENTS

The prevailing opinion seems to accept that the natural course of lumb ar spinal stenosis is one of progressive worsening, and that only surg ery can check this development. In fact, the choice of treatment for l umbar spinal stenosis is still an open question. The aim of this study was to compare in the matched-pair format the outcome of surgically a nd non-surgically treated patients with lumbar spinal stenosis. The su rgically treated group consisted of 496 patients who were operated on during the period 1974-1987 and 440 of whom were re-examined an averag e of 4.1 years after surgery. The non-surgically treated group consist ed of 57 patients who were treated conservatively during the period 19 80-1987 and were re-examined an average of 4.3 years after the start o f treatment. The matching criteria were sex, age, myelographic finding s, major symptom and duration of symptoms. Wie were able to form 54 si milar matched-pairs from the surgically and non-surgically treated pat ients. Subjective disability was assessed using the Oswestry questionn aire and functional status was evaluated during the clinical examinati on. For statistical analysis the McNemar test and the paired Student's t-test were used. The overall results showed no statistical differenc e in outcome between the matched-pair groups, but the operated men far ed significantly better than the non-operated men. The functional stat us was very good in both groups and for both sexes. In conclusion, con servative treatment of lumbar spinal stenosis should be considered for the patients with moderate stenosis. Controlled, prospective and rand omized trials are needed to clarify better the choice of treatment in patients with lumbar stenosis.