Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial.

Authors

• James N Weinstein
• Tor D Tosteson
• Jon D Lurie
• Anna Tosteson
• Emily Blood
• Harry Herkowitz
• Frank Cammisa
• Todd Albert
• Scott D Boden
• Alan Hilibrand
• Harley Goldberg
• Sigurd Berven
• Howard An

Publication/Presentation Date

6-15-2010

Abstract

STUDY DESIGN: Randomized trial and concurrent observational cohort study.

OBJECTIVE: To compare 4 year outcomes of surgery to nonoperative care for spinal stenosis.

SUMMARY OF BACKGROUND DATA: Surgery for spinal stenosis has been shown to be more effective compared to nonoperative treatment over 2 years, but longer-term data have not been analyzed.

METHODS: Surgical candidates from 13 centers in 11 US states with at least 12 weeks of symptoms and confirmatory imaging were enrolled in a randomized cohort (RC) or observational cohort (OC). Treatment was standard decompressive laminectomy or standard nonoperative care. Primary outcomes were SF-36 bodily pain (BP) and physical function scales and the modified Oswestry Disability index assessed at 6 weeks, 3 months, 6 months, and yearly up to 4 years.

RESULTS: A total of 289 patients enrolled in the RC and 365 patients enrolled in the OC. An as-treated analysis combining the RC and OC and adjusting for potential confounders found that the clinically significant advantages for surgery previously reported were maintained through 4 years, with treatment effects (defined as mean change in surgery group minus mean change in nonoperative group) for bodily pain 12.6 (95% confidence interval [CI], 8.5-16.7); physical function 8.6 (95% CI, 4.6-12.6); and Oswestry Disability index -9.4 (95% CI, -12.6 to -6.2). Early advantages for surgical treatment for secondary measures such as bothersomeness, satisfaction with symptoms, and self-rated progress were also maintained.

CONCLUSION: Patients with symptomatic spinal stenosis treated surgically compared to those treated nonoperatively maintain substantially greater improvement in pain and function through 4 years.

Volume

35

Issue

14

First Page

1329

Last Page

1338

ISSN

1528-1159

Published In/Presented At

Weinstein, J. N., Tosteson, T. D., Lurie, J. D., Tosteson, A., Blood, E., Herkowitz, H., Cammisa, F., Albert, T., Boden, S. D., Hilibrand, A., Goldberg, H., Berven, S., & An, H. (2010). Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine, 35(14), 1329–1338. https://doi.org/10.1097/BRS.0b013e3181e0f04d

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

20453723

Department(s)

Administration and Leadership

Document Type

Article