Evidence brief
Surgical vs Nonoperative Treatment for Lumbar Spinal Stenosis
Surgery superior to non-operative treatment at 4 years
Significant improvement in pain, function, and satisfaction
High crossover rate similar to disc herniation arm
Benefits maintained to 8-year follow-up in as-treated analysis
Fusion not routinely necessary for stenosis without instability
SPORT for stenosis showed more durable surgical benefit compared to disc herniation. Decompression provides significant improvement for neurogenic claudication.
For stenosis, SPORT showed surgery maintains superiority over time (unlike disc herniation). Discuss decompression alone vs with fusion - fusion reserved for instability, deformity, or spondylolisthesis. Know the indications for each.
Level I
Systematic review of RCTs or high-quality RCT