Rikke Rousing1, Rikke Krüger Jensen2,3,4, Søren Fruensgaard5, Janni Strøm5,6, Helle Algren Brøgger3,4,7, Jørgen Dan Møller Degn8, Mikkel Ø Andersen9. 1. Center for Spine Surgery and Research, Lillebaelt Hospital, Oestre Hougvej 55, 5500, Middelfart, Denmark. rikke.rousing@rsyd.dk. 2. Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. 3. Research Department, Spine Centre of Southern Denmark, Lillebaelt Hospital, Oestre Hougvej 55, 5500, Middelfart, Denmark. 4. Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 13, 3, 5000, Odense C, Denmark. 5. Department of Orthopaedic Surgery, Regionshospitalet Silkeborg, Hospitalsenhed Midt, Falkevej 1-3, 8600, Silkeborg, Denmark. 6. Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus Universtity, Bartholins Allé 2, 8000, Århus, Denmark. 7. University College South Denmark, Degnevej 16, 6705, Esbjerg Ø, Denmark. 8. Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Nordre Ringvej 57, 2600, Glostrup, Denmark. 9. Center for Spine Surgery and Research, Lillebaelt Hospital, Oestre Hougvej 55, 5500, Middelfart, Denmark.
Abstract
PURPOSE: To summarize the recommendations from the national clinical guideline published by the Danish Health Authority regarding surgical and nonsurgical interventions in treatment of lumbar spinal stenosis in patients above the age of 65 years. METHODS: A multidisciplinary working group formulated recommendations based on the GRADE approach. RESULTS: Seven of the recommendations were based on randomized controlled trials and three on professional consensus. The guideline recommends surgical decompression for symptomatic lumbar spinal stenosis. Supervised exercise and postsurgical supervised exercise are recommended due to the general beneficial effects of training on general health, even though there was no evidence on an effect on neurogenic pain. The guideline does not recommend manual therapy, paracetamol, NSAIDs, opioids, neurogenic pain medication, muscle relaxants, and decompression combined with instrumented fusion as there was no evidence of the beneficial effect. CONCLUSION: The recommendations are based on low to very low quality of evidence or professional consensus as well as patient preferences and positive or harmful effects of the intervention. The true treatment effect may therefore be different from the estimated effects, which is why the results should be interpreted with caution. The working group recommends intensified research in relation to all aspects of management of lumbar spinal stenosis. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: To summarize the recommendations from the national clinical guideline published by the Danish Health Authority regarding surgical and nonsurgical interventions in treatment of lumbar spinal stenosis in patients above the age of 65 years. METHODS: A multidisciplinary working group formulated recommendations based on the GRADE approach. RESULTS: Seven of the recommendations were based on randomized controlled trials and three on professional consensus. The guideline recommends surgical decompression for symptomatic lumbar spinal stenosis. Supervised exercise and postsurgical supervised exercise are recommended due to the general beneficial effects of training on general health, even though there was no evidence on an effect on neurogenic pain. The guideline does not recommend manual therapy, paracetamol, NSAIDs, opioids, neurogenic pain medication, muscle relaxants, and decompression combined with instrumented fusion as there was no evidence of the beneficial effect. CONCLUSION: The recommendations are based on low to very low quality of evidence or professional consensus as well as patient preferences and positive or harmful effects of the intervention. The true treatment effect may therefore be different from the estimated effects, which is why the results should be interpreted with caution. The working group recommends intensified research in relation to all aspects of management of lumbar spinal stenosis. These slides can be retrieved under Electronic Supplementary Material.
Entities:
Keywords:
Guideline; Lumbar spinal stenosis; Surgical and nonsurgical interventions
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