Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis

Peter A. Robertson; William R. Sears; John E. Cunningham

doi:10.7326/L15-5129-2

Letters |1 September 2015

Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis

Peter A. Robertson, MD; William R. Sears, MBBS; John E. Cunningham, BSc, MBBS, MClinEpi

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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 to be randomly assigned. No information on these patients was presented, but, on the basis of previous, larger, similar studies, these nonparticipants probably experienced greater disability than those who volunteered for randomization (2, 3). This factor raises doubts about this study's external validity.

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Letters |1 September 2015

Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis

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Letters |1 September 2015

Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis

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