Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review.

BACKGROUND Spinal stenosis can be treated both conservatively and with decompression surgery. OBJECTIVES To explore the effectiveness of surgery vs conservative treatment, and conservative interventions for spinal stenosis. DATA SOURCES Medline, CINAHL, AMED, PEDro and Cochrane databases, as well as the reference lists of retrieved studies. STUDY SELECTION The search included non-English studies, and all conservative interventions were included. STUDY APPRAISAL The PEDro scale was used to assess quality, and levels of evidence were used to synthesise studies where possible. RESULTS Thirty-one studies met the inclusion criteria, and 18 were high-quality studies. Decompression surgery was more effective than conservative care in four out of five studies, but only one of these was of high quality. In six high-quality studies, there was strong evidence that steroid epidural injections were not effective; in four out of five studies (two of which were of high quality), there was moderate evidence that calcitonin was not effective. There was no evidence for the effectiveness of all other conservative interventions. LIMITATIONS Further research is needed to determine if decompression surgery is more effective than conservative care, and which conservative care is most effective. CONCLUSION AND IMPLICATIONS At present, there is no evidence that favours the effect of any conservative management for spinal stenosis. There is an urgent need to see if any conservative treatment can change pain and functional outcomes in spinal stenosis.