Authors' objectives:

This report assesses the clinical evidence describing the natural history, diagnosis, and treatment of degenerative lumbar spinal stenosis (LSS). LSS causes low back pain, radiculopathy, and neurogenic claudication and impedes normal physical activity. LSS is commonly diagnosed in the elderly. Medicare records indicate that the rate of LSS surgery in the United States is between 30 and 132 per 100,000.

Authors' results and conclusions: Our meta-analyses, based on the few available studies, suggest that patients with congenitally narrower spinal canals are more likely to exhibit LSS symptoms and that patients with symptomatic LSS may have smaller canals. Considerable overlap exists between the spinal diameters of patients with and without LSS diagnoses. Some circumstantial evidence indicates that the development of symptomatic LSS may be influenced by patient age, weight, and occupation and osteoarthritis of the hips. Definitive conclusions cannot be made about the efficacy of diagnostic imaging methods or of conservative or surgical treatments for LSS. Evaluation of conservative treatment trials is complicated by the lack of patient inclusion criteria restricted to lumbar spinal stenosis. Evaluation of specific surgical techniques is difficult because relevant controlled studies often used demonstrably different patient groups. Trials that compare conservative to surgical treatment also fail to examine patients with similar clinical signs and symptoms. One randomized controlled trial provides evidence that patients with severe symptoms will benefit more from surgery than conservative therapy. Data from a single cohort study suggest that at one year after treatment, patients with moderate pain will benefit more from surgery than from conservative treatment.

Authors' recommendations: Definitive evidence-based statements about the diagnosis and treatment of LSS await the results of well-designed clinical trials. Available data imply that patients with narrower spinal canals may be more likely to develop some symptoms of LSS. The relationship between degree of stenosis and severity of symptoms is unclear and cannot be quantified. Some evidence suggests that patients with moderate to severe symptoms will benefit more from surgery than from conservative treatment.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/epcsums/stenosum.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)