Spinal stenosis: surgical versus nonsurgical treatment.

  • Atlas S
  • Delitto A
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Abstract

Lumbar spinal stenosis is being diagnosed increasingly in older people
as advanced imaging studies become more widely available and clinicians
become more familiar with the presentation of this common condition.
For symptomatic patients, the goal of treatment is pain relief and
improved function, but there is little empiric evidence to support
many of the common interventions used. The relative risks and benefits
of various surgical and nonsurgical treatments are poorly understood,
and the result has been wide variations in the evaluation and treatment
of spinal stenosis across geographic regions. Current practice recommendations
are based on expert opinion that incorporates available evidence
into existing clinical and biologic paradigms. For most individuals,
initial treatment should focus on patient education, medications
to control pain, and exercise and physical treatments to regain or
maintain activities of daily living. Surgical treatment most commonly
is considered in patients not improving with nonsurgical care. Decompressive
laminectomy is the standard surgical procedure for patients with
spinal stenosis. The addition of fusion with or without instrumentation
is considered when spinal stenosis is accompanied by degenerative
spondylolisthesis or related to concerns about instability. We review
the available evidence for nonsurgical and surgical interventions,
and highlight comparative results wherever applicable. LEVEL OF EVIDENCE:
Level V (expert opinion). See the Guidelines for Authors for a complete
description of levels of evidence.

Author-supplied keywords

  • Anti-Infective Agents
  • methods; Humans; Laminectomy; Lumbar Vertebrae; S
  • therapeutic use; Decision Making; Exercise Therap
  • therapy

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Authors

  • Steven J Atlas

  • Anthony Delitto

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