Surgery an Option for Spinal Stenosis
But Spinal Fusion Isn’t Needed, Researcher Says
Surgery Not the Only Option
In part of the study, 289 patients were randomly assigned to have surgery or nonsurgical treatments, including physical therapy and pain management.
But after two years, only 67% of the patients assigned to surgery had had the decompression procedure, and 43% of patients assigned to nonsurgical care had opted for surgery.
Another part of the study included 365 patients for whom no specific treatment was assigned. These patients were followed on their choices of surgical or nonsurgical treatment.
Though the surgically treated patients fared better in terms of pain and function in the combined analysis of both study parts, the researchers reported little evidence of harm from either treatment.
Surgery-related complications were uncommon, and patients treated without surgery showed some improvement over the two-year follow-up.
"Often patients fear they will get worse without surgery, but this was not the case for the majority of patients in the non-surgical group, who, on average, showed small improvements in all outcomes," the researchers write.
The message is clear, Weinstein says: Patients need to understand that surgery is not the only treatment option for spinal stenosis.
"Surgery is an elective procedure for this condition," he says. "Some patients find that they can live with their symptoms, and others find they can't. It is up to the physician to provide the information the patient needs to make an informed choice."
Clinician and back pain researcher Richard Deyo, MD, agrees.
Deyo is the Kaiser Permanente professor of evidence-based family medicine at the Oregon Health and Science University in Portland.
"The key is for patients to understand their choices and to understand what to expect from those choices," he says. "If they are well informed and clearly have a preference, this study finds that either surgical or nonsurgical treatment is a reasonable choice."