Surgery for spinal stenosis yields greater benefits over nonsurgical treatments

A research study by orthopedic spine, back and neck surgeon at Rush University Medical Center Dr. Howard An and colleagues found that patients who underwent surgery for spinal stenosis showed significantly more improvement in all primary outcomes than did patients who were treated nonsurgically.

The study findings were published in the New England Journal of Medicine, February 21.

Spinal stenosis involves a narrowing of a passage in the spine through which nerves pass, and it can result in a debilitating pain in the lower back, hips and legs. The surgical solution involves enlarging the opening to relieve the pressure on the nerves, in an operation called a laminectomy, one of the most common operations performed in the U.S.

The study results come from the Spine Patient Outcomes Research Trial sponsored by the National Institutes of Health that involved about 654 patients at 13 treatment centers across the country. Rush was the only medical center in Illinois involved in the study.

The study followed 654 surgical candidate patients with a history of at least 12 weeks of symptoms and spinal stenosis, of whom 398 ultimately received decompressive surgery. After two years, 63 percent of those who had surgery said they had a major improvement in their condition, compared with 29 percent among those who got nonsurgical treatment.

In terms of self-reported pain and function, both groups improved over the two-year period, though the final scores for patient who had surgery were in the 60-point range, while scores for those who stuck with nonsurgical treatments, such as physical therapy, were in the low 40s.

The study separated patients who stuck with their random assignment to surgery or nonsurgery options. The randomized patients' results were very similar to those who selected one course or the other.