Systematic Review of the Spine Patient Outcome Research Trial for Patients with Lumbar Spinal Stenosis

Abstract

BackgroundLumbar spinal stenosis (LSS) is the main cause of severe pain and disability. The long-term prognosis of surgical intervention for LSS is still controversial, and the reoperation rate is high. In 2002, the United States carried out a nearly 10-year multi-center spine patient effectiveness research trial (Spine Patient Outcomes Research Trial, SPORT) , which provided information on the suitability of surgery for lumbar disc herniation, LSS, and degenerative lumbar spondylolisthesis, in order to compare and analyze the clinical efficacy, cost-effectiveness, and prognostic factors of surgery and conservative treatment (non-surgical treatment) .ObjectiveTo summarize the results of the Spine Patient Outcome Research Trial (SPORT) on LSS, in order to provide ideas and methods for traditional Chinese medicine to intervene in LSS.MethodsPubMed, EMBase, The Cochrane Library, Web of Science database were retrieved by computer. The SPORT studies on surgical versus non-surgical for LSS or LSS subgroup analysis were included and the data was extracted and merged. The methodological quality of randomized controlled trials was evaluated using the Cochrane Collaboration "risk of bias" evaluation tool, and cohort studies or subgroup analysis were evaluated using the NOS scale.ResultsA total of 16 studies were included. In the 4-year follow-up, the efficacy of surgical intervention for LSS was significantly better than that of non-surgical therapy (P<0.05) . The difference in efficacy between surgery and non-surgical treatment was gradually reduced during the 8-year follow-up (P>0.05) . The total cost of surgery was more than twice that of non-surgical patients. Baseline ODI score greater than 56 points, elderly patients, and disease duration> 1 year are risk factors for surgical intervention for LSS were therisk factors for surgical intervention in LSS (P<0.05) .ConclusionSurgical therapy can significantly improve the symptoms of patients with LSS within 4 years, but there is no significant difference between surgical and non-surgical therapy in the long-term effect. As an important part of non-surgical therapy, Chinese medicine can refer to the methodology of the SPORT to establish a clinical research paradigm that conforms to the characteristics of clinical practice of Chinese medicine.

Keywords

• |spinal diseases|lumbar spinal stenosis|spine patient outcome research trial|systematic review