title: Nonoperative treatment for lumbar spinal stenosis. Clinical and outcome results and a 3-year survivorship analysis.
abstract: METHODS
  A cohort study of nonoperatively treated patients with lumbar spinal stenosis.
  
  
  OBJECTIVE
  To assess the effectiveness of aggressive nonsurgical treatment for lumbar spinal stenosis.
  
  
  BACKGROUND
  While surgical treatment of lumbar spinal stenosis has been widely accepted, the natural history of this condition is poorly documented. Moreover, the effect of other available therapies is unclear.
  
  
  METHODS
  Forty-nine patients meeting radiographic and clinical criteria for spinal stenosis underwent nonsurgical intervention consisting of therapeutic exercises, analgesics, and epidural steroid injections. Patients were followed for an average of 33 months. Outcome was assessed using a recently developed patient questionnaire for assessment of patients with lumbar spinal stenosis. Survival analysis was used to assess the probability of surgical intervention over the follow-up period.
  
  
  RESULTS
  At 3 years following treatment, 9 of the 49 patients had undergone surgical intervention. Of the remaining 40 unoperated patients, it is reported that two suffered significant motor deterioration, one of whom still reported overall symptoms as mild improvement, and the other as definite worsening. Five of the 40 unoperated patients reported feeling overall symptoms as probably or definitely worse, 12 reported no change, 11 reported only mild improvement, and 12 reported sustained improvement. Twelve of the 40 unoperated patients also had none or only mild pain.
  
  
  CONCLUSIONS
  The authors conclude that aggressive nonoperative treatment for spinal stenosis remains a reasonable option.
authors.affiliation: Physical Medicine and Rehabilitation Service, Hospital for Special Surgery, New York, New York, USA. simotas@hss.edu
authors.forename: A C
authors.initials: AC
authors.lastname: Simotas
authors.forename: F J
authors.initials: FJ
authors.lastname: Dorey
authors.forename: K K
authors.initials: KK
authors.lastname: Hansraj
authors.forename: F
authors.initials: F
authors.lastname: Cammisa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000706:statistics & numerical data*; D013130:Spinal Stenosis / Q000503:physiopathology / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome