Effects of Surgical versus Conservative Interventions of Lumbar Spinal Stenosis: A Critical Appraisal
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Abstract
Surgical Versus Non-Surgical Interventions for Treating Patients with Lumbar Spinal Stenosis: A Critically Appraised Topic
Adam Johnson & Caleb Radloff
Prof. Brandon Donahue, Prof. Nora Kraemer
Clinical Scenario:
Lumbar Spinal Stenosis (LSS) is classified as a narrowing of the spinal canal or nerve root foramen in the lumbar spine, commonly found in L3-L4 or L4-L5 junctions. Patients with this condition are severely limited in their ability to perform activities of daily living (ADLs) with surgery as the preferred treatment option. The purpose of this critical appraisal is to evaluate if surgical intervention or conservative intervention is best for treating patients with LSS.
Focused Clinical Question:
In patients with lumbar spinal stenosis (LSS) what are the effects of surgical interventions versus conservative interventions on physical function as measured by patient-reported outcomes?
Search Strategy:
Databases used to complete the search included PubMed, CINAHL, ProQuest Nursing Collection, and Cochrane Library. Search terms included "treatment of lumbar spinal stenosis" (30-455 results), "surgical versus non-surgical interventions for lumbar spinal stenosis" (5-500+ results), and "operative vs non-operative interventions for lumbar spinal stenosis" (7-500+ results). To quantify the effectiveness of each intervention we looked at studies that included patient-reported outcomes (PROs) to measure the physical function of patients before and after treatment. Inclusion Criteria consisted of patients with LSS and articles published 2004 and later. Exclusion criteria involved, patients with comorbidities, and studies where physical function was not measured. Nine articles matched our inclusion criteria and were used in this critical appraisal
Evidence-Quality Assessment:
The PEDro and the Oxford Center for Evidence-Based Medicine (OCEBM) scales were used to assess the quality of evidence. The PEDro scores for the studies included ranged from 4/10-8/10. All studies included scored a 2 on the OCEBM scale.
Results and Summary of Search:
All studies used some combination of the following PROs to evaluate intervention effectiveness: Visual Analog Scale (VAS), 36-item short form health survey (SF-36), Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ). All nine studies showed a significant improvement in pain and/or physical function for the surgical group. Three of nine studies utilized the SF-36 PRO and did not find a statistically significant difference in physical function for the surgical group.Two of the four studies that used the ODI form demonstrated a statistically significant improvement in physical function for both groups.
Clinical Bottom Line:
No consistencies were found in the evidence comparing conservative treatment to surgical intervention. Both surgical and conservative interventions are effective in treating patients with LSS. Surgical intervention should be used if the patient's condition is not improving after six months of conservative treatment. Strength of Recommendation Taxonomy (SORT) score was rated a B.
Implications:
Surgical interventions provide similar improvement regarding pain levels and physical function when compared to non-operative interventions. With this knowledge, athletic trainers can provide more treatment options for their patients. If non-surgical treatment is not effective, the AT can refer the patient to another healthcare provider to explore alternative options, such as surgical intervention. Future research should focus on what specific type of conservative treatment is most effective in improving physical function.
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Brandon Donahue
Second Advisor/Mentor
Nora Kraemer
Presentation Type
Oral Presentation
Effects of Surgical versus Conservative Interventions of Lumbar Spinal Stenosis: A Critical Appraisal
Surgical Versus Non-Surgical Interventions for Treating Patients with Lumbar Spinal Stenosis: A Critically Appraised Topic
Adam Johnson & Caleb Radloff
Prof. Brandon Donahue, Prof. Nora Kraemer
Clinical Scenario:
Lumbar Spinal Stenosis (LSS) is classified as a narrowing of the spinal canal or nerve root foramen in the lumbar spine, commonly found in L3-L4 or L4-L5 junctions. Patients with this condition are severely limited in their ability to perform activities of daily living (ADLs) with surgery as the preferred treatment option. The purpose of this critical appraisal is to evaluate if surgical intervention or conservative intervention is best for treating patients with LSS.
Focused Clinical Question:
In patients with lumbar spinal stenosis (LSS) what are the effects of surgical interventions versus conservative interventions on physical function as measured by patient-reported outcomes?
Search Strategy:
Databases used to complete the search included PubMed, CINAHL, ProQuest Nursing Collection, and Cochrane Library. Search terms included "treatment of lumbar spinal stenosis" (30-455 results), "surgical versus non-surgical interventions for lumbar spinal stenosis" (5-500+ results), and "operative vs non-operative interventions for lumbar spinal stenosis" (7-500+ results). To quantify the effectiveness of each intervention we looked at studies that included patient-reported outcomes (PROs) to measure the physical function of patients before and after treatment. Inclusion Criteria consisted of patients with LSS and articles published 2004 and later. Exclusion criteria involved, patients with comorbidities, and studies where physical function was not measured. Nine articles matched our inclusion criteria and were used in this critical appraisal
Evidence-Quality Assessment:
The PEDro and the Oxford Center for Evidence-Based Medicine (OCEBM) scales were used to assess the quality of evidence. The PEDro scores for the studies included ranged from 4/10-8/10. All studies included scored a 2 on the OCEBM scale.
Results and Summary of Search:
All studies used some combination of the following PROs to evaluate intervention effectiveness: Visual Analog Scale (VAS), 36-item short form health survey (SF-36), Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ). All nine studies showed a significant improvement in pain and/or physical function for the surgical group. Three of nine studies utilized the SF-36 PRO and did not find a statistically significant difference in physical function for the surgical group.Two of the four studies that used the ODI form demonstrated a statistically significant improvement in physical function for both groups.
Clinical Bottom Line:
No consistencies were found in the evidence comparing conservative treatment to surgical intervention. Both surgical and conservative interventions are effective in treating patients with LSS. Surgical intervention should be used if the patient's condition is not improving after six months of conservative treatment. Strength of Recommendation Taxonomy (SORT) score was rated a B.
Implications:
Surgical interventions provide similar improvement regarding pain levels and physical function when compared to non-operative interventions. With this knowledge, athletic trainers can provide more treatment options for their patients. If non-surgical treatment is not effective, the AT can refer the patient to another healthcare provider to explore alternative options, such as surgical intervention. Future research should focus on what specific type of conservative treatment is most effective in improving physical function.
