Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis
Authors: Peter A. Robertson, William R. Sears, John E. Cunningham
Journal: Annals of Internal Medicine (2015)

Letters1 September 2015Surgery Versus Nonsurgical Treatment of Lumbar Spinal StenosisPeter A. Robertson, MD, William R. Sears, MBBS, and John E. Cunningham, BSc, MBBS, MClinEpiPeter A. Robertson, MDFrom Auckland Hospital, Auckland, New Zealand; Wentworth Spine Clinic, Sydney, Australia; and Royal Melbourne Hospital, Melbourne, Australia.Search for more papers by this author, William R. Sears, MBBSFrom Auckland Hospital, Auckland, New Zealand; Wentworth Spine Clinic, Sydney, Australia; and Royal Melbourne Hospital, Melbourne, Australia.Search for more papers by this author, and John E. Cunningham, BSc, MBBS, MClinEpiFrom Auckland Hospital, Auckland, New Zealand; Wentworth Spine Clinic, Sydney, Australia; and Royal Melbourne Hospital, Melbourne, Australia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-5129-2 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We congratulate Delitto and colleagues (1) for conducting a randomized, controlled trial comparing surgery with PT for the treatment of lumbar spinal stenosis (LSS). However, we have serious concerns about their methods, particularly their interpretation of the results. We do not agree that the study shows that “surgical decompression yielded similar effects to a PT regimen among patients with LSS who were surgical candidates.” We believe that adherence to intention-to-treat analysis severely distorts the results and leads to erroneous conclusions.Figure 1 indicates that almost two thirds of suitable patients (312 of 481) declined to participate and ...References1. Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015;162:465-73. [PMID: 25844995] doi:10.7326/M14-1420 LinkGoogle Scholar2. Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2010;35:1329-38. [PMID: 20453723] doi:10.1097/BRS.0b013e3181e0f04d CrossrefMedlineGoogle Scholar3. Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, et al. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2008;33:2789-800. [PMID: 19018250] doi:10.1097/BRS.0b013e31818ed8f4 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Auckland Hospital, Auckland, New Zealand; Wentworth Spine Clinic, Sydney, Australia; and Royal Melbourne Hospital, Melbourne, Australia.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L15-0316. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSurgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Anthony Delitto , Sara R. Piva , Charity G. Moore , Julie M. Fritz , Stephen R. Wisniewski , Deborah A. Josbeno , Mark Fye , and William C. Welch Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Steven J. Barrer Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Alfonse T. Masi and Sam Betts Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Anthony Delitto , Sara R. Piva , Charity G. Moore , and William C. Welch Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Alfonse T. Masi and Sam Betts Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Anthony Delitto , Sara R. Piva , Charity G. Moore , and William C. Welch Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Steven J. Barrer Metrics 1 September 2015Volume 163, Issue 5Page: 396-397KeywordsCohort studiesDisabilitiesDisclosureEvidence based medicineIntent to treat analysisStenosisSurgery ePublished: 1 September 2015 Issue Published: 1 September 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...