Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis

Lumbar spinal stenosis is the most common reason for spinal surgery in patients over the age of 65 years. This randomized clinical trial compared surgical decompression with nonsurgical therapy for spinal stenosis without spondylolisthesis. Although the trial was limited by frequent crossover between the two randomized groups and therefore was not definitive, the findings favored surgical decompression over nonsurgical care for this common spine disorder. This trial compared surgical decompression with nonsurgical therapy for spinal stenosis without spondylolisthesis. The findings favored surgical decompression over nonsurgical care for this common spine disorder. Spinal stenosis is a narrowing of the spinal canal with encroachment on the neural structures by surrounding bone and soft tissue. Patients typically present with radicular leg pain or with neurogenic claudication (pain in the buttocks or legs on walking or standing that resolves with sitting down or lumbar flexion). Spinal stenosis is the most common reason for lumbar spine surgery in adults over the age of 65 years. 1 , 2 Indications for surgery appear to vary widely, and rates of procedures vary by at least a factor of 5 across geographic areas. 3 , 4 Radiographic evidence of stenosis is frequently asymptomatic; . . .