Lumbar spinal stenosis: Conservative or surgical management? A prospective10-year study

Study Design. A cohort of 100 patients with symptomatic lumbar spinal steno sis, characterized in a previous article, were given surgical or conservati ve treatment and followed for 10 years. Objectives. To identify the short- and long-term results after surgical and conservative treatment, and to determine whether clinical or radiologic pr edictors for the treatment result can be defined. Summary of Background Data. Surgical decompression has been considered the rational treatment. However, clinical experience indicates that many patien ts do well with conservative treatment. Methods. In this study, 19 patients with severe symptoms were selected for surgical treatment and 50 patients with moderate symptoms for conservative treatment, whereas 31 patients were randomized between the conservative (n = 18) and surgical (n = 13) treatment groups. Pain was decisive for the cho ice of treatment group. All patients were observed for 10 years by clinical evaluation and questionnaires. The results, evaluated by patient and physi cian, were rated as excellent, fair, unchanged, or worse. Results. After a period of 3 months,relief of pain had occurred in most pat ients. Some had relief earlier, whereas for others it took 1 year. After a period of 4 years, excellent or fair results were found in half of the pati ents selected for conservative treatment, and in four fifths of the patient s selected for surgery. Patients with an unsatisfactory result from conserv ative treatment were offered delayed surgery after 3 to 27 months (median, 3.5 months). The treatment result of delayed surgery was essentially simila r to that of the initial group. The treatment result for the patients rando mized for surgical treatment was considerably better than for the patients randomized for conservative treatment. Clinically significant deterioration of symptoms during the final 6 years of the follow-up period was not obser ved. Patients with multilevel afflictions, surgically treated or not, did n ot have a poorer outcome than those with single-level afflictions. Clinical or radiologic predictors for the final outcome were not found. There were no dropouts, except for 14 deaths. Conclusions. The outcome was most favorable for surgical treatment. However , an initial conservative approach seems advisable for many patients becaus e those with an unsatisfactory result can be treated surgically later with a good outcome.