SPORT spinal stenosis

Surgical versus nonsurgical therapy for lumbar spinal stenosis

Weinstein JN, Tosteson TD, Lurie JD, et al. The New England journal of medicine 2008 · PMID 18287602 · doi:10.1056/nejmoa0707136

Question

Does decompressive laminectomy improve outcomes compared with non-operative care for degenerative lumbar spinal stenosis without spondylolisthesis?

Design

Multicentre US RCT with a concurrent observational cohort (part of SPORT).

Patients

Adults with at least 12 weeks of neurogenic claudication or radicular symptoms and imaging-confirmed lumbar stenosis without spondylolisthesis.

Intervention

Standard posterior decompressive laminectomy

Comparison

Usual non-operative care

Primary outcome

SF-36 bodily pain and physical function, and Oswestry Disability Index at 2 years

Key result

In as-treated analysis surgery gave significantly greater improvement in pain and function at 2 years; intention-to-treat analysis showed a significant benefit only for bodily pain because of crossover.

Limitations

Substantial crossover and reliance on as-treated analysis introduce selection bias.

Impact on practice

Supports offering decompression to patients with persistent symptomatic stenosis who have failed non-operative management.