The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review

<p>Abstract</p> <p>Background</p> <p>Lumbar spinal stenosis (LSS) is prevalent in those over the age of 65 years and the leading cause of spinal surgery in this population. Recent systematic reviews have examined the effectiveness of conservative management for LSS, but...

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Main Authors: Jarrett Mark S, Orlando Joseph F, Grimmer-Somers Karen
Format: Article
Language:English
Published: BMC 2012-02-01
Series:BMC Musculoskeletal Disorders
Online Access:http://www.biomedcentral.com/1471-2474/13/30
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spelling doaj-8040e4aab7b5442da74e97edd783ed0b2020-11-24T21:11:59ZengBMCBMC Musculoskeletal Disorders1471-24742012-02-011313010.1186/1471-2474-13-30The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic reviewJarrett Mark SOrlando Joseph FGrimmer-Somers Karen<p>Abstract</p> <p>Background</p> <p>Lumbar spinal stenosis (LSS) is prevalent in those over the age of 65 years and the leading cause of spinal surgery in this population. Recent systematic reviews have examined the effectiveness of conservative management for LSS, but not relative to surgical interventions. The aim of this review was to systematically examine the effectiveness of land based exercise compared with decompressive surgery in the management of patients with LSS.</p> <p>Methods</p> <p>A systematic review of randomised controlled trials and clinical trials was undertaken. The databases MEDLINE, Embase, CINAHL, PEDro and Cochrane Library Register of Controlled Trials were searched from January 2000 to June 2011. Only studies that included subjects with lumbar spinal canal stenosis were considered in this review. Studies also had to use a patient reported functional outcome measure for a land based exercise intervention or lumbar decompressive surgery.</p> <p>Results</p> <p>Only one study compared the effectiveness of exercise and decompressive surgery for LSS. Surgery demonstrated statistically significant improvements in patient reported functional outcome scores at 6, 12 and 24-months post-intervention (<it>p </it>< 0.01). To facilitate further analysis, the results from 12 exercise and 10 surgical intervention arms were compared using percentage change in patient reported functional outcome measure scores. Exercise interventions showed initial improvements, ranging from 16 to 29% above baseline. All decompressive surgical interventions demonstrated greater and sustained improvements over 2-years (range 38-67% improvement) with moderate to large effect sizes. The most commonly reported complications associated with surgery were dural tears, while details of adverse effects were lacking in exercise interventions.</p> <p>Conclusions</p> <p>This systematic review of the recent literature demonstrates that decompressive surgery is more effective than land based exercise in the management of LSS. However, given the condition's slowly progressive nature and the potential for known surgical complications, it is recommended that a trial of conservative management with land based exercise be considered prior to consideration of surgical intervention.</p> http://www.biomedcentral.com/1471-2474/13/30
collection DOAJ
language English
format Article
sources DOAJ
author Jarrett Mark S
Orlando Joseph F
Grimmer-Somers Karen
spellingShingle Jarrett Mark S
Orlando Joseph F
Grimmer-Somers Karen
The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review
BMC Musculoskeletal Disorders
author_facet Jarrett Mark S
Orlando Joseph F
Grimmer-Somers Karen
author_sort Jarrett Mark S
title The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review
title_short The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review
title_full The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review
title_fullStr The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review
title_full_unstemmed The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review
title_sort effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review
publisher BMC
series BMC Musculoskeletal Disorders
issn 1471-2474
publishDate 2012-02-01
description <p>Abstract</p> <p>Background</p> <p>Lumbar spinal stenosis (LSS) is prevalent in those over the age of 65 years and the leading cause of spinal surgery in this population. Recent systematic reviews have examined the effectiveness of conservative management for LSS, but not relative to surgical interventions. The aim of this review was to systematically examine the effectiveness of land based exercise compared with decompressive surgery in the management of patients with LSS.</p> <p>Methods</p> <p>A systematic review of randomised controlled trials and clinical trials was undertaken. The databases MEDLINE, Embase, CINAHL, PEDro and Cochrane Library Register of Controlled Trials were searched from January 2000 to June 2011. Only studies that included subjects with lumbar spinal canal stenosis were considered in this review. Studies also had to use a patient reported functional outcome measure for a land based exercise intervention or lumbar decompressive surgery.</p> <p>Results</p> <p>Only one study compared the effectiveness of exercise and decompressive surgery for LSS. Surgery demonstrated statistically significant improvements in patient reported functional outcome scores at 6, 12 and 24-months post-intervention (<it>p </it>< 0.01). To facilitate further analysis, the results from 12 exercise and 10 surgical intervention arms were compared using percentage change in patient reported functional outcome measure scores. Exercise interventions showed initial improvements, ranging from 16 to 29% above baseline. All decompressive surgical interventions demonstrated greater and sustained improvements over 2-years (range 38-67% improvement) with moderate to large effect sizes. The most commonly reported complications associated with surgery were dural tears, while details of adverse effects were lacking in exercise interventions.</p> <p>Conclusions</p> <p>This systematic review of the recent literature demonstrates that decompressive surgery is more effective than land based exercise in the management of LSS. However, given the condition's slowly progressive nature and the potential for known surgical complications, it is recommended that a trial of conservative management with land based exercise be considered prior to consideration of surgical intervention.</p>
url http://www.biomedcentral.com/1471-2474/13/30
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