CONSERVATIVE VERSUS SURGICAL APPROACHES FOR CHRONIC LOW BACK PAIN ASSOCIATED WITH LUMBAR SPINAL STENOSIS: A SYSTEMATIZED REVIEW
DOI:
https://doi.org/10.56238/levv16n55-038Keywords:
Lumbar Spinal Stenosis, Surgical Decompression, Conservative Treatment, Chronic Low Back PainAbstract
Introduction: Lumbar spinal stenosis is a common cause of chronic low back pain and functional limitation in adults, managed through either conservative measures or surgical decompression. Despite the widespread use of both strategies, the long-term superiority of one approach over the other remains uncertain. Methods: A systematic review was conducted using PubMed, Embase, Cochrane Library, and Scopus, including randomized controlled trials, prospective cohorts, and systematic reviews comparing surgical and conservative treatment in adults with symptomatic lumbar stenosis. Outcomes analyzed included pain, functional disability (ODI), quality of life (SF-36), walking capacity, complications, and reoperations. Evidence synthesis was performed qualitatively and complemented by descriptive quantitative analysis of key findings. Results: Surgery consistently demonstrated superior outcomes during the first 1–2 years, with greater reduction in pain, more pronounced functional improvement, and better quality-of-life scores. However, this advantage progressively diminished after 5–10 years, with convergence of results between the two groups in long-term follow-up. Complication and reoperation rates were substantially higher in the surgical cohort, while conservative treatment exhibited a favorable safety profile and satisfactory clinical response in 30–40% of patients. Methodological heterogeneity across studies—particularly regarding conservative protocols—limited direct comparability. Conclusion: Surgical decompression offers superior short-term clinical benefit, particularly in moderate to severe cases, but its advantage tends to decline over extended follow-up. Conservative management remains a valid option for patients with milder symptoms or adequate early response. These findings highlight the importance of individualized therapeutic decision-making based on functional status, risk-benefit assessment, and patient expectations.
Downloads
References
1. Weinstein, J. N., Tosteson, T. D., Lurie, J. D., Tosteson, A. N. A., Blood, E. A., Hanscom, B., et al. (2008). Surgical versus nonsurgical therapy for lumbar spinal stenosis. The New England Journal of Medicine, 358(8), 794–810.
2. Weinstein, J. N., Tosteson, T. D., Lurie, J. D., Tosteson, A. N. A., Blood, E. A., Herkowitz, H., et al. (2010). Surgical versus nonoperative treatment for lumbar spinal stenosis: Four-year results of the Spine Patient Outcomes Research Trial. Spine, 35(14), 1329–1338.
3. Delitto, A., Piva, S. R., Moore, C. G., Fritz, J. M., Wisniewski, S. R., Josbeno, D. A., et al. (2015). Surgery versus nonsurgical treatment of lumbar spinal stenosis: A randomized trial. Annals of Internal Medicine, 162(7), 465–473.
4. Malmivaara, A., Slätis, P., Heliövaara, M., Sainio, P., Kinnunen, H., Kankare, J., et al. (2007). Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine, 32(1), 1–8.
5. Slätis, P., Malmivaara, A., Heliövaara, M., Sainio, P., Kinnunen, H., Kankare, J., et al. (2011). Long-term results of surgery for lumbar spinal stenosis: A randomized controlled trial. European Spine Journal, 20(7), 1174–1181.
6. Amundsen, T., Weber, H., Lilleås, F., Nordal, H. J., Abdelnoor, M., & Magnaes, B. (2000). Lumbar spinal stenosis: Conservative or surgical management? A prospective 10-year study. Spine, 25(11), 1424–1435.
7. Atlas, S. J., Keller, R. B., Robson, D., Deyo, R. A., & Singer, D. E. (2000). Surgical and nonsurgical management of lumbar spinal stenosis: Four-year outcomes from the Maine Lumbar Spine Study. Spine, 25(5), 556–562.
8. Atlas, S. J., Keller, R. B., Wu, Y. A., Deyo, R. A., & Singer, D. E. (2005). Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8- to 10-year results from the Maine Lumbar Spine Study. Spine, 30(8), 936–943.
9. Kovacs, F. M., Urrútia, G., & Alarcón, J. D. (2011). Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: A systematic review of randomized controlled trials. Spine, 36(20), E1335–E1351.
10. Ma, X. L., Zhao, X. W., Ma, J. X., Li, F., Wang, Y., & Lu, B. (2017). Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: A system review and meta-analysis of randomized controlled trials. International Journal of Surgery, 44, 329–338.
11. Zaina, F., Tomkins-Lane, C., Carragee, E., & Negrini, S. (2016). Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database of Systematic Reviews, 2016(1), CD010264.
12. Zaina, F., Tomkins-Lane, C., Carragee, E., & Negrini, S. (2016). Surgical versus nonsurgical treatment for lumbar spinal stenosis. Spine, 41(14), E857–E868.
13. Machado, G. C., Ferreira, P. H., Harris, I. A., Pinheiro, M. B., Koes, B. W., van Tulder, M., Rzewuska, M., Maher, C. G., & Ferreira, M. L. (2015). Effectiveness of surgery for lumbar spinal stenosis: A systematic review and meta-analysis. PLOS ONE, 10(3), e0122800.
14. Wei, F.-L., Zhou, C.-P., Li, T.-F., Ma, X.-L., & Ma, J.-X. (2021). Management for lumbar spinal stenosis: A network meta-analysis and systematic review. International Journal of Surgery, 85, 19–28.
15. Inoue, G., Miyagi, M., & Takaso, M. (2016). Surgical and nonsurgical treatments for lumbar spinal stenosis. European Journal of Orthopaedic Surgery & Traumatology, 26(7), 695–704.
