Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis
Authors: Anthony Delitto, Sara R. Piva, Charity G. Moore, William C. Welch
Journal: Annals of Internal Medicine (2015)

Letters1 September 2015Surgery Versus Nonsurgical Treatment of Lumbar Spinal StenosisAnthony Delitto, PT, PhD, Sara R. Piva, PT, PhD, Charity G. Moore, PhD, MSPH, and William C. Welch, MDAnthony Delitto, PT, PhDFrom University of Pittsburgh, Pittsburgh, Pennsylvania., Sara R. Piva, PT, PhDFrom University of Pittsburgh, Pittsburgh, Pennsylvania., Charity G. Moore, PhD, MSPHFrom University of Pittsburgh, Pittsburgh, Pennsylvania., and William C. Welch, MDFrom University of Pittsburgh, Pittsburgh, Pennsylvania.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-5129-4 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with Dr. Barrer that conservative care should precede considering surgery. However, we disagree that not having prior PT is a "breach of … care." Exactly what constitutes conservative care is not universally agreed upon. Physical therapy is 1 form, as is watchful waiting, epidural steroids, drug regimens, and many combinations. In our study, surgeons deemed patients surgical candidates largely because conservative care—including, in some cases, previous PT—had been unsuccessful.As for the high crossover rate, complier average causal effect and inverse probability weighting analyses were done to address that issue. In terms of success rates of ...References1. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, et al; SPORT Investigators. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358:794-810. [PMID: 18287602] doi:10.1056/NEJMoa0707136 CrossrefMedlineGoogle Scholar2. Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J, et al; Finnish Lumbar Spinal Research Group. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine (Phila Pa 1976). 2007;32:1-8. [PMID: 17202885] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Pittsburgh, Pittsburgh, Pennsylvania.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1420. 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 Peter A. Robertson , William R. Sears , and John E. Cunningham Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Alfonse T. Masi and Sam Betts Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Alfonse T. Masi and Sam Betts Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Peter A. Robertson , William R. Sears , and John E. Cunningham Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis Steven J. Barrer Metrics Cited byEmerging Issues Questioning the Current Treatment Strategies for Lumbar Disc HerniationOrthopaedic Randomized Controlled Trials Published in General Medical Journals Are Associated With Higher Altmetric Attention Scores and Social Media Attention Than Nonorthopaedic Randomized Controlled TrialsLong-Term Follow-Up of Spinal Stenosis Inpatients Treated with Integrative Korean Medicine TreatmentDecompression Surgery versus Interspinous Devices for Lumbar Spinal Stenosis: A Systematic Review of the LiteratureComprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized TrialComparative effectiveness and prognostic factors for outcome of surgical and non-surgical management of lumbar spinal stenosis in an elderly population: protocol for an observational studyLumbar Spinal Stenosis in Older AdultsIndividuals with lumbar spinal stenosis seek education and care focused on self-management—results of focus groups among participants enrolled in a randomized controlled trialLumbar spinal stenosis: symptoms, diagnosis and treatment (meta-analysis of literature data)LombalgiesSurgical management of lumbar spinal stenosis: a survey among Norwegian spine surgeons 1 September 2015Volume 163, Issue 5Page: 397-398KeywordsDisclosureDrug therapyIntent to treat analysisPhysiotherapySpineSportsStenosisSteroidsSurgeonsSurgery ePublished: 1 September 2015 Issue Published: 1 September 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...