The researchers enrolled surgical candidates who had a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis to a randomised cohort (n = 289) or an observational cohort (n = 365) at 13 US spine clinics. The participants received decompressive surgery or their usual nonsurgical care.

The primary outcomes measured were bodily pain and physical function on the Medical Outcomes Study 36-item Short-Form General Health Survey and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, 1 year, and 2 years.

At 2 years, the researchers found that 67% of patients who were randomly assigned to surgery had undergone surgery, and 43% of those who were randomly assigned to receive nonsurgical care had also undergone surgery. Moreover, 63% of those who had surgery said they had a major improvement in their condition compared with only 29% among those who had received nonsurgical treatment.

With regard to self-reported pain and function, both study groups noted improvement during the 2-year period; however, the final scores for patients who had surgery were in the 60-point range. Scores for participants who received nonsurgical treatments, such as physical therapy, were in the low 40s.

An as-treated analysis, which combined the results of both cohorts and was adjusted for potential confounders, showed that there was a significant advantage for surgery by 3 months for all primary outcomes, and the authors noted that these changes remained significant at 2 years.


SOURCE: New England Journal of Medicine, February 21, 2008

Copyright © 2009 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content.