Prognosis

Results of one study on the natural history of symptomatic lumbar stenosis showed that at 4 years, walking tolerance declined in about 30% of patients, but symptoms improved or remained stable in the remainder.[81] Some predictive signs that clinical symptoms may worsen include dural sac cross-sectional area <50 mm2, presence of radicular symptoms and back pain, degenerative spondylolisthesis and/or scoliosis, and symptom duration >1 year.[23]

Prognosis in patients initially treated with medical or physical therapy is variable. Studies show that among treated patients without surgery, about 50% remain unchanged, 25% improve, and 25% worsen (mean follow-up was 49 months, range 10 to 103 months).[81]

Several prospective studies have shown significantly improved long-term (4 to 6 years) outcomes in patients treated surgically rather than nonsurgically.[82][83] In the Maine Lumbar Spine Study, patients undergoing surgery as their initial treatment had better leg pain relief and greater back-related functional status after 8-10 years of follow-up. However, favorable long-term outcomes were only reported by about one half of the patients, regardless of the initial treatment given.[84]

Short-term and intermediate surgical outcomes are generally very good to excellent. A success rate of 78% to 88% was found at 6 weeks and 6 months; this rate dropped to 70% at 1 year and 5 years.[85] Analysis of a 5-year follow-up of post-laminectomy patients showed excellent results at 2 years (67%), but this fell to only 52% at 5 years, and 18% of patients underwent another operation.[86] Studies show that surgery can be performed safely with satisfactory results in many patients aged 70-89 years who can otherwise tolerate the procedure.[87][88] Recurrence of back pain can occur after surgery. Patients may initially have improvement in symptoms and subsequently deteriorate over time. One study found 27% recurrence of symptoms after 5 years of follow-up.[89] Re-stenosis at the operated level, stenosis at a new level, development of herniated lumbar disk, and late instability are among the reasons for failed surgery.[89] Generally, 75% of these surgical failures respond to further surgery. Results from the Spine Patient Outcomes Research Trial (SPORT) trial demonstrated that patients treated nonoperatively improved minimally while those treated surgically improved significantly more, at up to 4 years of follow-up.[60] This was apparent in all primary and secondary outcomes including SF-36 bodily pain, physical function, and in the Oswestry Disability Index. Similar findings were observed for patients with degenerative spondylolisthesis.[60]

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