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.[78] 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 physiotherapy 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).[78]

Several prospective studies have shown significantly improved long-term (4 to 6 years) outcomes in patients treated surgically rather than non-surgically.[79][80] 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 to 10 years of follow-up. However, favourable long-term outcomes were only reported by about one half of the patients, regardless of the initial treatment given.[81]

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.[82] 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.[83] Studies show that surgery can be performed safely with satisfactory results in many patients aged 70-89 years who can otherwise tolerate the procedure.[84][85] 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.[86] Re-stenosis at the operated level, stenosis at a new level, development of herniated lumbar disc and late instability are among the reasons for failed surgery.[86] Generally, 75% of these surgical failures respond to further surgery. Results from the Spine Patient Outcomes Research Trial (SPORT) trial demonstrated that patients treated non-operatively improved minimally while those treated surgically improved significantly more, at up to 4 years of follow-up.[59] 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.[59]

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