Nonoperative Treatment for Lumbar Spinal Stenosis

Abstract

STUDY DESIGN: A cohort study of nonoperatively treated patients with lumbar spinal stenosis. OBJECTIVE: To assess the effectiveness of aggressive nonsurgical treatment for lumbar spinal stenosis. BACKGROUND DATA: While surgical treatment of lumbar spinal stenosis has been widely accepted, the natural history of this condition is poorly documented. Moreover, the effect of other available therapies is unclear. METHODS: Forty-nine patients meeting radiographic and clinical criteria for spinal stenosis underwent nonsurgical intervention consisting of therapeutic exercises, analgesics, and epidural steroid injections. Patients were followed for an average of 33 months. Outcome was assessed using a recently developed patient questionnaire for assessment of patients with lumbar spinal stenosis. Survival analysis was used to assess the probability of surgical intervention over the follow-up period. RESULTS: At 3 years following treatment, 9 of the 49 patients had undergone surgical intervention. Of the remaining 40 unoperated patients, it is reported that two suffered significant motor deterioration, one of whom still reported overall symptoms as mild improvement, and the other as definite worsening. Five of the 40 unoperated patients reported feeling overall symptoms as probably or definitely worse, 12 reported no change, 11 reported only mild improvement, and 12 reported sustained improvement. Twelve of the 40 unoperated patients also had none or only mild pain. CONCLUSIONS: The authors conclude that aggressive nonoperative treatment for spinal stenosis remains a reasonable option.