title: Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial.
abstract: METHODS
  Randomized trial and concurrent observational cohort study.
  
  
  OBJECTIVE
  To compare 4 year outcomes of surgery to nonoperative care for spinal stenosis.
  
  
  BACKGROUND
  Surgery for spinal stenosis has been shown to be more effective compared to nonoperative treatment over 2 years, but longer-term data have not been analyzed.
  
  
  METHODS
  Surgical candidates from 13 centers in 11 US states with at least 12 weeks of symptoms and confirmatory imaging were enrolled in a randomized cohort (RC) or observational cohort (OC). Treatment was standard decompressive laminectomy or standard nonoperative care. Primary outcomes were SF-36 bodily pain (BP) and physical function scales and the modified Oswestry Disability index assessed at 6 weeks, 3 months, 6 months, and yearly up to 4 years.
  
  
  RESULTS
  A total of 289 patients enrolled in the RC and 365 patients enrolled in the OC. An as-treated analysis combining the RC and OC and adjusting for potential confounders found that the clinically significant advantages for surgery previously reported were maintained through 4 years, with treatment effects (defined as mean change in surgery group minus mean change in nonoperative group) for bodily pain 12.6 (95% confidence interval [CI], 8.5-16.7); physical function 8.6 (95% CI, 4.6-12.6); and Oswestry Disability index -9.4 (95% CI, -12.6 to -6.2). Early advantages for surgical treatment for secondary measures such as bothersomeness, satisfaction with symptoms, and self-rated progress were also maintained.
  
  
  CONCLUSIONS
  Patients with symptomatic spinal stenosis treated surgically compared to those treated nonoperatively maintain substantially greater improvement in pain and function through 4 years.
authors.affiliation: Department of Orthopaedics, Dartmouth Medical School, Hanover, NH 03756, USA. SPORT@dartmouth.edu
authors.forename: James N
authors.initials: JN
authors.lastname: Weinstein
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.forename: Jon D
authors.initials: JD
authors.lastname: Lurie
authors.forename: Anna
authors.initials: A
authors.lastname: Tosteson
authors.forename: Emily
authors.initials: E
authors.lastname: Blood
authors.forename: Harry
authors.initials: H
authors.lastname: Herkowitz
authors.forename: Frank
authors.initials: F
authors.lastname: Cammisa
authors.forename: Todd
authors.initials: T
authors.lastname: Albert
authors.forename: Scott D
authors.initials: SD
authors.lastname: Boden
authors.forename: Alan
authors.initials: A
authors.lastname: Hilibrand
authors.forename: Harley
authors.initials: H
authors.lastname: Goldberg
authors.forename: Sigurd
authors.initials: S
authors.lastname: Berven
authors.forename: Howard
authors.initials: H
authors.lastname: An
mesh_terms: D000368:Aged; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000379:methods; D017116:Low Back Pain / Q000150:complications / Q000601:surgery / Q000628:therapy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013130:Spinal Stenosis / Q000150:complications / Q000601:surgery* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
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