Original Article
The natural clinical course of lumbar spinal stenosis: a longitudinal cohort study over a minimum of 10 years

https://doi.org/10.1007/s00776-013-0435-9Get rights and content

Abstract

Background

Little is known about the short- and long-term prognoses of conservative treatment of lumbar spinal stenosis (LSS). Furthermore, there are no reports in the literature that investigate the relationship between longitudinal imaging changes and clinical symptoms in patients with LSS. This longitudinal cohort study aimed to clarify the morphologic changes and role of conservative treatment in LSS.

Methods

This study included 34 patients with leg or low back pain who had received a diagnosis of LSS by magnetic resonance imaging (MRI). The patients’ average age was 58 years at the initial examination. All participants received conservative treatment with or without medication for over 10 years. The clinical course was assessed by using the Japanese Orthopaedic Association scoring system, a visual analog scale for back or leg pain, and symptomatic Johnsson’s classification. Additionally, patients’ dural sac cross-sectional area was measured on axial MRI.

Results

One patient could not be contacted and four others died during this investigation. After an average follow-up of 11.1 years, symptoms improved in approximately 30 % of patients, remained unchanged in 30 %, and worsened in 30 %. The dural sac cross-sectional areas in both the worsened and unchanged groups were significantly smaller than that of the improved group (P < 0.05). In the worsened group, the average area at the initial examination was <50 mm2. Some patients underwent surgery during this observation, and had severe narrowing (<40 mm2) of the area at the initial examination.

Conclusions

This study showed that clinical symptoms of LSS did not develop in more than 60 % of patients who received conservative treatment, which was dependent on the severity of LSS. In patients with severe LSS and a dural sac cross-sectional area <50 mm2, the clinical course may deteriorate with conservative treatment, and surgery should be considered at an early stage.

References (25)

  • D.K. Sengupta et al.

    Lumbar spinal stenosis

    Treatment strategies and indications for surgery. Orthop Clin North Am

    (2003)
  • A. Naylor

    Factors in the development of the spinal stenosis syndrome

    J Bone Jt Surg Br

    (1979)
  • F. Postacchini

    Lumbar spinal stenosis

    (1988)
  • J.E. Jeffrey et al.

    Antenatal factors in the development of the lumbar vertebral canal: a magnetic resonance imaging study

    Spine

    (2003)
  • T. Amundsen et al.

    Lumbar spinal stenosis: conservative or surgical management? A prospective 10-year study

    Spine

    (2000)
  • S.J. Atlas et al.

    Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the main lumbar spine study

    Spine

    (2000)
  • H.N. Herkowitz et al.

    Degenerative lumbar spondylolisthesis with spinal stenosis

    A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Jt Surg Am

    (1991)
  • J.A. Turner et al.

    Surgery for lumbar spinal stenosis

    Attempted meta-analysis of the literature. Spine

    (1992)
  • A. Herno et al.

    Long-term results of surgical treatment of lumbar spinal stenosis

    Spine

    (1993)
  • D. Grob et al.

    Degenerative lumbar spinal stenosis

    J Bone Jt Surg Am

    (1995)
  • J.N. Katz et al.

    Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spine stenosis

    Spine

    (1996)
  • B. Jonsson et al.

    A prospective and consecutive study of surgically treated lumbar spinal stenosis

    Part I: clinical features related to radiographic findings. Spine

    (1997)
  • Cited by (0)

    View full text