Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial

Ann Intern Med. 2015 Apr 7;162(7):465-73. doi: 10.7326/M14-1420.


Background: Primary care management decisions for patients with symptomatic lumbar spinal stenosis (LSS) are challenging, and nonsurgical guidance is limited by lack of evidence.

Objective: To compare surgical decompression with physical therapy (PT) for LSS and evaluate sex differences.

Design: Multisite randomized, controlled trial. ( NCT00022776).

Setting: Neurologic and orthopedic surgery departments and PT clinics.

Participants: Surgical candidates with LSS aged 50 years or older who consented to surgery.

Intervention: Surgical decompression or PT.

Measurements: Primary outcome was physical function score on the Short Form-36 Health Survey at 2 years assessed by masked testers.

Results: The study took place from November 2000 to September 2007. A total of 169 participants were randomly assigned and stratified by surgeon and sex (87 to surgery and 82 to PT), with 24-month follow-up completed by 74 and 73 participants in the surgery and PT groups, respectively. Mean improvement in physical function for the surgery and PT groups was 22.4 (95% CI, 16.9 to 27.9) and 19.2 (CI, 13.6 to 24.8), respectively. Intention-to-treat analyses revealed no difference between groups (24-month difference, 0.9 [CI, -7.9 to 9.6]). Sensitivity analyses using causal-effects methods to account for the high proportion of crossovers from PT to surgery (57%) showed no significant differences in physical function between groups.

Limitation: Without a control group, it is not possible to judge success attributable to either intervention.

Conclusion: Surgical decompression yielded similar effects to a PT regimen among patients with LSS who were surgical candidates. Patients and health care providers should engage in shared decision-making conversations that include full disclosure of evidence involving surgical and nonsurgical treatments for LSS.

Primary funding source: National Institutes of Health and National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Decompression, Surgical* / adverse effects
  • Female
  • Humans
  • Intention to Treat Analysis
  • Lumbar Vertebrae* / surgery
  • Male
  • Physical Therapy Modalities*
  • Reoperation
  • Sex Factors
  • Spinal Stenosis / surgery
  • Spinal Stenosis / therapy*
  • Surgical Wound Infection / etiology
  • Treatment Outcome
  • Wound Healing

Associated data