What is the treatment effect of surgery compared with nonoperative treatment in patients with lumbar spinal stenosis at 1-year follow-up?

Held, Ulrike; Steurer, Johann; Pichierri, Giuseppe; Wertli, Maria Monika; Farshad, Mazda; Brunner, Florian; Guggenberger, Roman; Porchet, François; Fekete, Tamás F; Schmid, Urs D; Gravestock, Isaac; Burgstaller, Jakob M (2019). What is the treatment effect of surgery compared with nonoperative treatment in patients with lumbar spinal stenosis at 1-year follow-up? (In Press). Journal of neurosurgery - spine, pp. 1-9. American Association of Neurological Surgeons 10.3171/2019.1.SPINE181098

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Objective The aim of this study was to obtain an unbiased causal treatment estimate of the between-group difference of surgery versus nonoperative treatment with respect to outcomes on quality of life, pain, and disability in patients with degenerative lumbar spinal stenosis (DLSS) 12 months after baseline. Methods The authors included DLSS patients from a large prospective multicenter observational cohort study. Propensity score matching was used, including 15 demographic, clinical, and MRI variables. Linear and logistic mixed-effects regression models were applied to quantify the between-group treatment effect. Unmeasured confounding was addressed in a sensitivity analysis, assessing the robustness of the results. Results A total of 408 patients were included in this study, 222 patients after matching, with 111 in each treatment group. Patients with nonoperative treatment had lower quality of life at the 12-month follow-up (−6.21 points, 95% CI −9.93 to −2.49) as well as lower chances of reaching a minimal clinically important difference in Spinal Stenosis Measure (SSM) symptoms (OR 0.26, 95% CI 0.13 to 0.53) and SSM function (OR 0.26, 95% CI 0.14 to 0.49), than patients undergoing surgery. These results were very robust in case of unmeasured confounding. The surgical complication rate was low; 5 (4.5%) patients experienced a durotomy during intervention, and 5 (4.5%) patients underwent re-decompression. Conclusions The authors used propensity score matching to assess the difference in treatment efficacy of surgery compared with nonoperative treatment in elderly patients with DLSS. This study delivers strong evidence that surgical treatment is superior to nonoperative treatment. It helps in clinical decision-making, especially when patients suffer for a long time, sometimes over many years, hoping for a spontaneous improvement of their symptoms. In light of these new results, the number of years with disability can hopefully be reduced by providing adequate treatment at the right time for this ever-growing elderly and frail population. Abbreviations DLSS = degenerative lumbar spinal stenosis; HADS = Hospital Anxiety and Depression Scale; ITT = intention-to-treat; LSOS = Lumbar Stenosis Outcome Study; MCID = minimal clinically important difference; RCT = randomized controlled trial; SMD = standardized mean difference; SSM = Spinal Stenosis Measure.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Wertli, Maria Monika


600 Technology > 610 Medicine & health




American Association of Neurological Surgeons




Christine Baumgartner

Date Deposited:

25 Jun 2019 10:53

Last Modified:

22 Oct 2019 19:03

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

DLSS = degenerative lumbar spinal stenosis HADS = Hospital Anxiety and Depression Scale ITT = intention-to-treat LSOS = Lumbar Stenosis Outcome Study MCID = minimal clinically important difference RCT = randomized controlled trial SMD = standardized mean difference SSM = Spinal Stenosis Measure confounding degenerative lumbar spinal stenosis matching propensity score sensitivity analysis surgery





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