Long-Term Outcomes of Surgical and Nonsurgical Management of Lumbar Spinal Stenosis: 8 to 10 Year Results from the Maine Lumbar Spine Study

• DOI: 10.1097/01.brs.0000158953.57966.c0
• Publication Date: 2005-04-13T15:11:00Z
• Authors: Steven J. Atlas; Robert B. Keller; Yen A. Wu; Richard A. Deyo; Daniel E. Singer
• Keywords: Male; Reoperation; Leg; Lumbar Vertebrae; Time Factors; Palliative Care; Pain; Middle Aged; 3. Good health; Cohort Studies; 03 medical and health sciences; Spinal Stenosis; Treatment Outcome; 0302 clinical medicine; Patient Satisfaction; Humans; Female; Longitudinal Studies; Prospective Studies; Low Back Pain; Aged

In Brief Study Design. A prospective observational cohort study. Objective. To assess long-term outcomes of patients with lumbar spinal stenosis treated surgically or nonsurgically. Summary Background Data. The relative benefit various treatments for is uncertain. Surgical treatment has been associated short-term improvement, but recurrence symptoms documented. Few studies have compared surgical and nonsurgical treatments. Methods. Patients recruited from the practices orthopaedic surgeons, neurosurgeons, occupational medicine physicians throughout Maine had baseline interviews follow-up questionnaires mailed at regular intervals over 10 years. Clinical data were obtained a physician questionnaire. Most initially undergoing surgery laminectomy without fusion performed. Outcomes including patient-reported leg back pain, functional status, satisfaction assessed 8- to 10-year follow-up. Primary analyses based on initial received secondary examining actual by Results. Of 148 eligible consenting enrolled, 105 alive after years (67.7% survival rate). Among surviving patients, between 8 was available 97 123 (79%) (including 11 who died before completed 9 year survey); 56 63 (89%) 41 60 (68%) worse status than those 1 4 favored treatment. After years, similar percentage reported that their low pain improved(53% vs. 50%, P = 0.8), predominant symptom (either pain) improved (54% 42%, 0.3), they satisfied current (55% 49%, 0.5). These group findings persisted adjustment other determinants outcome in multivariate models. However, less severe greater improvement back-specific nonsurgically patients. By 23% undergone least one additional spine operation, 39% operation. subsequent procedures continuing according did not differ because individuals Conclusions. completing follow-up, relief, state relief back-related continued favor receiving results support shared decision-making approach among when considering options stenosis. prospectively followed included symptoms, care. While regardless treatment, status.