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European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

25.07.2016 | General Review • SPINE - TUMORS

Surgical and nonsurgical treatments for lumbar spinal stenosis

verfasst von: Gen Inoue, Masayuki Miyagi, Masashi Takaso

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 7/2016

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Abstract

Lumbar spinal stenosis (LSS) is the most common indication for spinal surgery in older adults; however, the efficacy of surgery for LSS as compared to nonsurgical treatments remains unclear. Here, we reviewed numerous studies, including randomized control trails (RCTs), to compare nonsurgical and surgical treatments for LSS. The nonsurgical management of LSS includes medication, epidural injections, physiotherapy, lifestyle modification, and multidisciplinary rehabilitative approaches. Patients with LSS who do not improve after nonsurgical treatments are typically treated surgically using decompressive surgery, which has the strongest evidence base. Although decompressive surgical treatment is associated with modestly successful outcomes, it remains unclear whether decompression combined with fusion surgery results in clinical outcomes that are superior to those following decompression surgery alone. Future RCTs assessing the effectiveness of specific treatments based on high-quality scientific evidence are expected to aid clinical decision-making and improve treatment outcomes for LSS.

Deyo RA (2010) Treatment of lumbar spinal stenosis: a balancing act. Spine J 10(7):625–627PubMedCrossRef

Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI (2005) United States trends in lumbar fusion surgery for degenerative conditions. Spine 30(12):1441–1445 PubMedCrossRef

Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis (2011) The North American Spine Society Evidence-Based Guideline. https://www.spine.org/Portals/0/Documents/ResearchClinicalCare/Guidelines/LumbarStenosis.pdf

Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleâs F (2000) Lumbar spinal stenosis: conservative or surgical management? A prospective 10-year study. Spine 25(11):1424–1435PubMedCrossRef

Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J, Dalin-Hirvonen N, Seitsalo S, Herno A, Kortekangas P, Niinimäki T, Rönty H, Tallroth K, Turunen V, Knekt P, Härkänen T, Hurri H (2007) Finnish Lumbar Spinal Research Group. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine 32(1):1–8PubMedCrossRef

Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, Johnson DR 2nd, Skidmore GA, Vessa PP, Dwyer JW, Puccio ST, Cauthen JC, Ozuna RM (2005) A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results. Spine 30(12):1351–1358PubMedCrossRef

Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H, Investigators SPORT (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358(8):794–810PubMedPubMedCentralCrossRef

Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, Cammisa F, Albert T, Boden SD, 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):1329–1338PubMedPubMedCentralCrossRef

Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, Fye M, Welch WC (2015) Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med 162(7):465–473PubMedCrossRef

10.

Brown LL (2012) A double-blind, randomized, prospective study of epidural steroid injection vs. the mild^® procedure in patients with symptomatic lumbar spinal stenosis. Pain Pract 12(5):333–341PubMedCrossRef

11.

Atlas SJ, Deyo RA, Keller RB, Chapin AM, Patrick DL, Long JM, Singer DE (1996) The maine lumbar spine study, part III: 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine 21(15):1787–1794PubMedCrossRef

12.

Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE (2000) Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine 25(5):556–562PubMedCrossRef

13.

Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine 30(8):936–943PubMedCrossRef

14.

Chang Y, Singer DE, Wu YA, Keller RB, Atlas SJ (2005) The effect of surgical and nonsurgical treatment on longitudinal outcomes of lumbar spinal stenosis over 10 years. J Am Geriatr Soc 53(5):785–792PubMedCrossRef

15.

Ammendolia C, Stuber KJ, Rok E, Rampersaud R, Kennedy CA, Pennick V, Steenstra IA, de Bruin LK, Furlan AD (2013) Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst Rev 8:CD010712PubMed

16.

Matsudaira K, Seichi A, Kunogi J, Yamazaki T, Kobayashi A, Anamizu Y, Kishimoto J, Hoshi K, Takeshita K, Nakamura K (2009) The efficacy of prostaglandin E1 derivative in patients with lumbar spinal stenosis. Spine 34(2):115–120PubMedCrossRef

17.

Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483PubMedCrossRef

18.

Porter RW, Hibbert C (1983) Calcitonin treatment for neurogenic claudication. Spine 8(6):585–592PubMedCrossRef

19.

Sahin F, Yilmaz F, Kotevoglu N, Kuran B (2009) The efficacy of physical therapy and physical therapy plus calcitonin in the treatment of lumbar spinal stenosis. Yonsei Med J 50(5):683–688PubMedPubMedCentralCrossRef

20.

Tafazal SI, Ng L, Sell P (2007) Randomised placebo-controlled trial on the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis. Eur Spine J 16(2):207–212PubMedCrossRef

21.

Podichetty VK, Segal AM, Lieber M, Mazanec DJ (2004) Effectiveness of salmon calcitonin nasal spray in the treatment of lumbar canal stenosis: a double-blind, randomized, placebo-controlled, parallel group trial. Spine 29(21):2343–2349PubMedCrossRef

22.

Porter RW, Miller CG (1988) Neurogenic claudication and root claudication treated with calcitonin. A double-blind trial. Spine 13(9):1061–1064PubMedCrossRef

23.

Eskola A, Pohjolainen T, Alaranta H, Soini J, Tallroth K, Slätis P (1992) Calcitonin treatment in lumbar spinal stenosis: a randomized, placebo-controlled, double-blind, cross-over study with one-year follow-up. Calcif Tissue Int 50(5):400–403PubMedCrossRef

24.

Waikakul W, Waikakul S (2000) Methylcobalamin as an adjuvant medication in conservative treatment of lumbar spinal stenosis. J Med Assoc Thail 83(8):825–831

25.

Yaksi A, Ozgönenel L, Ozgönenel B (2007) The efficiency of gabapentin therapy in patients with lumbar spinal stenosis. Spine 32(9):939–942PubMedCrossRef

26.

Kim HJ, Kim JH, Park YS, Suk KS, Lee JH, Park MS, Moon SH (2016) Comparative study of the efficacy of limaprost and pregabalin as single agents and in combination for the treatment of lumbar spinal stenosis: a prospective, double-blind, randomized controlled non-inferiority trial. Spine J 16(6):756–763PubMedCrossRef

27.

Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine 25(22):2940–2952PubMedCrossRef

28.

T.E. Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208CrossRef

29.

Cohen SP, Hanling S, Bicket MC, White RL, Veizi E, Kurihara C, Zhao Z, Hayek S, Guthmiller KB, Griffith SR, Gordin V, White MA, Vorobeychik Y, Pasquina PF (2015) Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study. BMJ 350:h1748PubMedPubMedCentralCrossRef

30.

Karppinen J, Malmivaara A, Kurunlahti M, Kyllönen E, Pienimäki T, Nieminen P, Ohinmaa A, Tervonen O, Vanharanta H (2001) Periradicular infiltration for sciatica: a randomized controlled trial. Spine 26(9):1059–1067PubMedCrossRef

31.

Ghahreman A, Ferch R, Bogduk N (2010) The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain. Pain Med 11(8):1149–1168PubMedCrossRef

32.

Arden NK, Price C, Reading I, Stubbing J, Hazelgrove J, Dunne C, Michel M, Rogers P, Cooper C (2005) WEST study group. A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study. Rheumatology 44(11):1399–1406PubMedCrossRef

33.

Wilson-MacDonald J, Burt G, Griffin D, Glynn C (2005) Epidural steroid injection for nerve root compression. A randomised, controlled trial. J Bone Joint Surg Br 87(3):352–355PubMedCrossRef

34.

Fukusaki M, Kobayashi I, Hara T, Sumikawa K (1998) Symptoms of spinal stenosis do not improve after epidural steroid injection. Clin J Pain 14(2):148–151PubMedCrossRef

35.

Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, Truchon R, Parent F, Levésque J, Bergeron V, Montminy P, Blanchette C (1997) Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 336(23):1634–1640PubMedCrossRef

36.

Dilke TF, Burry HC, Grahame R (1973) Extradural corticosteroid injection in management of lumbar nerve root compression. Br Med J 2(5867):635–637PubMedPubMedCentralCrossRef

37.

Iversen T, Solberg TK, Romner B, Wilsgaard T, Twisk J, Anke A, Nygaard O, Hasvold T, Ingebrigtsen T (2011) Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial. BMJ 343:d5278PubMedPubMedCentralCrossRef

38.

Manchikanti L, Knezevic NN, Boswell MV, Kaye AD, Hirsch JA (2016) Epidural injections for lumbar radiculopathy and spinal stenosis: a comparative systematic review and meta-analysis. Pain Phys 19(3):E365–E410

39.

Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, Bauer Z, Bresnahan BW, Avins AL, Nedeljkovic SS, Nerenz DR, Standaert C, Kessler L, Akuthota V, Annaswamy T, Chen A, Diehn F, Firtch W, Gerges FJ, Gilligan C, Goldberg H, Kennedy DJ, Mandel S, Tyburski M, Sanders W, Sibell D, Smuck M, Wasan A, Won L, Jarvik JG (2014) A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 371(1):11–21PubMedCrossRef

40.

Roland M, Morris R (1983) A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. Spine 8(2):145–150PubMedCrossRef

41.

Manchikanti L, Cash KA, McManus CD, Damron KS, Pampati V, Falco FJ (2015) A randomized, double-blind controlled trial of lumbar interlaminar epidural injections in central spinal stenosis: 2-year follow-up. Pain Phys 18(1):79–92

42.

Sayegh FE, Kenanidis EI, Papavasiliou KA, Potoupnis ME, Kirkos JM, Kapetanos GA (2009) Efficacy of steroid and nonsteroid caudal epidural injections for low back pain and sciatica: a prospective, randomized, double-blind clinical trial. Spine 34(14):1441–1447PubMedCrossRef

43.

Ghai B, Kumar K, Bansal D, Dhatt SS, Kanukula R, Batra YK (2015) Effectiveness of parasagittal interlaminar epidural local anesthetic with or without steroid in chronic lumbosacral pain: a randomized, double-blind clinical trial. Pain Phys 18(3):237–248

44.

Olmarker K, Larsson K (1998) Tumor necrosis factor alpha and nucleus-pulposus-induced nerve root injury. Spine 23(23):2538–2544PubMedCrossRef

45.

Ohtori S, Miyagi M, Eguchi Y, Inoue G, Orita S, Ochiai N, Kishida S, Kuniyoshi K, Nakamura J, Aoki Y, Ishikawa T, Arai G, Kamoda H, Suzuki M, Takaso M, Furuya T, Toyone T, Takahashi K (2012) Epidural administration of spinal nerves with the tumor necrosis factor-alpha inhibitor, etanercept, compared with dexamethasone for treatment of sciatica in patients with lumbar spinal stenosis: a prospective randomized study. Spine 37(6):439–444PubMedCrossRef

46.

Pua YH, Cai CC, Lim KC (2007) Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomised controlled trial. Aust J Physiother 53(2):83–89PubMedCrossRef

47.

Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, Garber MB, Bennett AC, Fritz JM (2006) A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine 31(22):2541–2549PubMedCrossRef

48.

Overdevest GM, Jacobs W, Vleggeert-Lankamp C, Thomé C, Gunzburg R, Peul W (2015) Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. Cochrane Database Syst Rev 3:CD010036PubMed

49.

Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 8(6):968–974PubMedCrossRef

50.

Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, Johnson DR 2nd, Skidmore GA, Vessa PP, Dwyer JW, Puccio S, Cauthen JC, Ozuna RM (2004) A prospective randomized multi-center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1-year results. Eur Spine J 13(1):22–31 PubMedCrossRef

51.

Lindsey DP, Swanson KE, Fuchs P, Hsu KY, Zucherman JF, Yerby SA (2003) The effects of an interspinous implant on the kinematics of the instrumented and adjacent levels in the lumbar spine. Spine 28(19):2192–2197PubMedCrossRef

52.

Stucki G, Liang MH, Fossel AH, Katz JN (1995) Relative responsiveness of condition-specific and generic health status measures in degenerative lumbar spinal stenosis. J Clin Epidemiol 48(11):1369–1378PubMedCrossRef

53.

Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN (1996) Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine 21(7):796–803PubMedCrossRef

54.

Patel VV, Nunley PD, Whang PG, Haley TR, Bradley WD, Davis RP, Block JE, Geisler FH (2015) Superion(^®) InterSpinous Spacer for treatment of moderate degenerative lumbar spinal stenosis: durable three-year results of a randomized controlled trial. J Pain Res 8:657–662PubMedPubMedCentral

55.

Imajo Y, Taguchi T, Yone K, Okawa A, Otani K, Ogata T, Ozawa H, Shimada Y, Neo M, Iguchi T (2015) Japanese 2011 nationwide survey on complications from spine surgery. J Orthop Sci 20(1):38–54PubMedCrossRef

56.

Bae HW, Rajaee SS, Kanim LE (2013) Nationwide trends in the surgical management of lumbar spinal stenosis. Spine 38(11):916–926PubMedCrossRef

57.

Försth P, Ólafsson G, Carlsson T, Frost A, Borgström F, Fritzell P, Öhagen P, Michaëlsson K, Sandén B (2016) A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 374(15):1413–1423PubMedCrossRef

58.

Strömqvist B, Fritzell P, Hägg O, Jönsson B, Sandén B (2013) Swedish society of spinal surgeons. swespine: the Swedish spine register: the 2012 report. Eur Spine J 22(4):953–974PubMedPubMedCentralCrossRef

59.

Yang JS, Cho YJ, Kang SH, Choi HJ (2016) Dynamic radiographic results of different semi-rigid fusion devices for degenerative lumbar spondylolisethesis: “dynamic rod” vs. “dynamic screw head”. Truk Neurosurg 26(2):268–273

60.

De Iure F, Bosco G, Cappuccio M, Paderni S, Amendola L (2012) Posterior lumbar fusion by peek rods in degenerative spine: prelim reports on 30 cases. Eur Spine J 21(Suppl 1):S50–S54PubMedCrossRef

61.

Zaina F, Tomkins-Lane C, Carragee E, Negrini S (2016) Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev 1:CD010264PubMed

Titel: Surgical and nonsurgical treatments for lumbar spinal stenosis
verfasst von: Gen Inoue
Masayuki Miyagi
Masashi Takaso
Publikationsdatum: 25.07.2016
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 7/2016
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-016-1818-3

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