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James Walter, BS

NewYork

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Debate About Aurgery Of Apinal Stenosis

Despite multiple randomized and observational studies demonstrating a benefit of surgery relative to non-operative treatment for spinal stenosis patients experiencing claudication or radiculopathy, a Cochrane review article concluded that there was insufficient evidence to conclude that surgery resulted in better outcomes. Some of the randomized trials were limited by crossover between the groups, and the observational studies had significant baseline differences between the two groups. An online paper writing service offers an original spinal cure papers crafted by our professional essay writers. These phenomenon are to be expected, and there is likely no way to prevent crossover from non-operative treatment to surgery in an RCT on this topic.





In order to add further data to the literature, the Lumbar Stenosis Outcomes Study (LSOS) was designed to track outcomes following surgery or non-operative treatment for patients with lumbar spinal stenosis. This observational study included 679 patients treated at eight Swiss centers and followed them for 3 years. Approximately 60% underwent surgery within 1 year of enrollment, one third never had surgery, and 18 patients had surgery between one and three years. Not surprisingly, the surgery patients were somewhat younger, healthier, and had worse baseline symptoms and more severe stenosis at baseline.




They were also more likely to report buttock or lower extremity pain and were more likely to have spondylolisthesis. Over three quarters of the surgery patients had decompression alone, and 22% had a fusion. The majority of patients had a multilevel decompression. Always choose the best write my paper service that guarantees timely delivery of essays related to spinal cure.

After controlling for baseline differences, the surgery patients improved significantly more on the Spinal Stenosis Measure (SSM) symptoms and function subscales and on the EQ-5D compared to the non-operative patients, who tended not to improve much from baseline. The patients who had surgery after 1 year did not do better than the non-operative patients. There was an overall reoperation rate of 15% in the surgical group, most of which were for restenosis. The authors concluded that surgery resulted in greater degrees of improvement for lumbar stenosis patients out to 3 years.

This paper represents a high quality observational study, and the authors reasonably concluded that surgery resulted in better outcomes than non-operative treatment. The main limitation of this study, like all observational studies, is that there were baseline differences between the two groups for which the statistical analysis likely did not completely control.




Given that an RCT probably cannot be performed to answer this question without substantial crossover, observational studies with good statistical analyses likely represent the best study design for this topic. While these studies do not provide ironclad Level 1 evidence, one can reasonably conclude that for patients with moderate to severe lumbar stenosis with neurogenic claudication or radiculopathy, surgery likely results in better outcomes than non-operative care. Always choose the best college essay examples that guarantees quality essay work related to spinal cure.

This study included a heterogeneous mix of patients with and without spondylolisthesis, and 22% underwent a fusion. The authors cast a broad net in terms of the inclusion criteria, which increases the generalizability of the study but limits conclusions about specific patient groups or surgical techniques. At this point, the Spine Patient Outcomes Research Trial, the Maine Lumbar Spine Study, and now the LSOS have provided high quality observational data suggesting that surgery improves outcomes more than non-operative treatment for spinal stenosis.





Rather than performing more studies to prove this point, the spine community should focus on matching the right treatment to the right patient at the right time. Always choose the best college essay that guarantees quality essay work related to topic of spinal cure. Producing research that allows for evidence-based individualized care is very challenging and requires huge numbers of patients in order to perform the type of subgroup analyses necessary to answer questions at a sufficiently fine level of granularity. That is the next step for researchers focused on degenerative lumbar conditions.