The results of a study Spanish definitely dissipate doubts on what patients with spinal stenosis which is worthwhile to operate.

-The study defines what should be the sequence of treatment of patients with spinal stenosis symptom.

– identifies patients where surgery has proven to be the best option, and those in which there is no basis to raise it

– between the different surgical techniques availablethe most simple (and cheap) are more secure and perform better than the most complex

Madrid, November 2011- spinal stenosis is the narrowing of the bony canal which runs the marrow and often does not cause any problem. However, in some cases it is progressive and reaches compress nerve roots, which causes severe pain in the leg. It is the most common reason for surgery of back between the age 65 or over.

Various treatments, conservatives (pharmacological and rehabilitation) are used in these patients and surgical. But not a rigorous research on the comparative effectiveness of surgery and nonsurgical treatment for spinal stenosis, allowing to define criteria for the indication for each type of treatment was available until now.

A Spanish study has resolved definitively ” the doubts in this area. Thus specifies the main international scientific journal on spinal column, Spine, in his editorial. “We should congratulate the authors, since that is the definitive study in this field of research ” emphasizes the publication.

“The systematic review, driven by the Kovacs Foundation and co-financed by the Foundation itself with health research fund, used the most rigorous methods to identify all the studies conducted so far on this issue, analyze detail its characteristics and each scientific quality, and summarize their results in a few clear recommendations.

Its findings show that there is no basis to consider surgery in patients who do not have pain intense radiating leg (though they suffer from back pain and an MRI or CT show spinal stenosis), or those where irradiated pain lasts less than six months or improvement with conservative treatment.

Instead ”, indicates Dr. Francisco Kovacs, Director of the Spanish network of researchers on back problems and first author of the study, if radiated pain limits the quality of life of the patient and lasts more than 6 months despite conservative treatment is more effective to operate it which prolong treatment ”. the superiority of surgery manifests itself quickly and staysas a minimum, over 4 years, and probably 10 ” Apostille.

Notwithstanding ”, points out Dr. Gerard Urrútia, the epidemiology service of the Hospital de Sant Pau and the Iberoamerican Cochrane Centre, co-author of the study, delaying surgery not worsens the prognosis or exposes the patient to serious risks, therefore there is no urgency and is the patient who has to decide whether the limitations that cause pain justify the risks inherent in any surgery”.

Indications and risks of each treatment type

This study allows structured treatment as a whole on the basis of the indications and risks of each type of procedure. Thus, in patients in which an MRI or CT shows spinal stenosis:

-If there is no irradiated pain in the leg (although there is back pain), spinal stenosis should be considered only as a casual and irrelevant finding, that or it is a cause of problems or require treatment in itself same.

– in patients that spinal stenosis causes pain radiating to the leg, you must apply conservative treatment during the first 6 months.

-If this treatment despite the pain persists after that period and is sufficiently intense or limiting, is more effective to operate on the patient who maintain conservative therapy over more time.

– If the patient has more than 50 years, leg pain is only visible when walking and disappears when sitting down ( claudication neur)(ógena ”), and there is no exceeding the I grade spondylolisthesis ” (i.e. the vertebrae are relatively well aligned), makes sense consider the placement of a interespinoso device ” between the vertebrae. It is a minimally invasive which leads to less blood loss than classical surgery and shortens stay hospital.

– If the patient does not meet these criteria, or the device has failed, be judged classical surgery. The surgery involves removing the portion of enough bone to decompress the nerve root ( decompression surgery ”). Only in very specific cases (essentially, when the stenosis is due to a spondylolisthesis ” progressive) is justified, moreover, to fuse the vertebrae ( fusion ”); in such cases techniques of simpler Arthrodesis (without apparatus, or with the least possible), are more secure and perform better than involving the introduction of more devices.

It would be advisable to immediately apply these criteria in the national health system, since currently tends to operate on patients where it is not necessary to do so, and to perform techniques unnecessarily complex, primarily for fixing the vertebrae, that expose patients to more risks, generate exorbitant costs and do worse.

In its response to the editorial commentary of the magazine, the authors point out that the study identifies patients where surgery is indicated, and point to taking into account growing surgery unnecessarily aggressive and expensive in most Western countries and the high rates ”, it is important to highlight that also helps identify patients for which there is no evidence that the surgery is useful ”.

In our institutions – concludes – the results of this review have dispelled doubts about the criteria to recommend surgery for patients with symptomatic spinal stenosis, and they have helped us provide more and better information about treatment alternatives and the expected results, in order to help them decide reasonably with respect to their own treatment ”.

Next steps

From the research point of view, the authors of this systematic review indicate that the next steps ought to be, first, to assess the effectiveness of each kind of conservative treatment which is used in these patients, both for applying them clinically (and discarding the useless), so that in future studies surgery can be compared to treatments targeted troops (and not)(, until now, a miscellaneous ” of conservative treatment which includes some of unknown or doubtful efficacy).

Also, indicate the need for studies comparing patients in which the placement of an interespinoso device is indicated its results, risks and costs in comparison to conventional surgery, in order to determine what technique is advisable in such cases, given that so far they have only compared separately both procedures versus conservative treatment.