International Centre for Allied Health Evidence, University of South Australia, North Terrace, Adelaide, SA 5000, Australia.
BMC Musculoskelet Disord. 2012 Feb 28;13:30. doi: 10.1186/1471-2474-13-30.
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.
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.
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 (p < 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.
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.
腰椎管狭窄症（LSS）在 65 岁以上人群中较为常见，也是该人群中脊柱手术的主要原因。最近的系统评价已经检查了保守治疗 LSS 的效果，但没有与手术干预进行比较。本综述的目的是系统地检查陆地运动与减压手术在 LSS 患者管理中的有效性。
进行了一项随机对照试验和临床试验的系统评价。从 2000 年 1 月至 2011 年 6 月，检索了 MEDLINE、Embase、CINAHL、PEDro 和 Cochrane 对照试验登记处数据库。本综述仅考虑了纳入腰椎管狭窄患者的研究。研究还必须使用陆地运动干预或腰椎减压手术的患者报告功能结局测量来进行研究。
只有一项研究比较了运动和减压手术治疗 LSS 的效果。手术在 6、12 和 24 个月的干预后在患者报告的功能结局评分方面显示出统计学上显著的改善（p < 0.01）。为了便于进一步分析，使用患者报告的功能结局测量评分的百分比变化比较了 12 个运动和 10 个手术干预组的结果。运动干预显示出初始改善，基线以上提高 16%至 29%。所有减压手术干预在 2 年内显示出更大且持续的改善（改善幅度为 38%-67%），具有中等至大的效果大小。与手术相关的最常见并发症是硬脊膜撕裂，而运动干预中缺乏不良反应的详细信息。
对近期文献的系统评价表明，减压手术在 LSS 的治疗中比陆地运动更有效。然而，鉴于该疾病的缓慢进展性质和已知手术并发症的可能性，建议在考虑手术干预之前，先考虑采用陆地运动进行保守治疗。
