Prepared by:
ECRI, Plymouth Meeting, PA
Health Technology Assessment Group
File Name Description Software Version File Size __________________________________________________________________________________________________________ 001front.doc Microsoft Word® Document MS Word® 97 SR-1 26KB 5 pages Contents: Title Page; Preface 002abstr.doc Microsoft Word® Document MS Word® 97 SR-1 23KB 2 pages Contents: Structured Abstract 003conts.doc Microsoft Word® Document MS Word® 97 SR-1 33KB 4 pages Contents: Table of Contents (Volume 1) 004summ.doc Microsoft Word® Document MS Word® 97 SR-1 57KB 10 pages Contents: Summary 005chap1.doc Microsoft Word® Document MS Word® 97 SR-1 136KB 17 pages Contents: Chapter 1. Introduction: Scope and Purpose of This Report; Epidemiology of Lumbar Spinal Stenosis; Natural History of Lumbar Spinal Stenosis; Burden of Disease; Patterns of Care 006tbl1.doc Microsoft Word® Document MS Word® 97 SR-1 44KB 2 pages Contents: Table 1. National low back pain study patient characteristics and syndromes 007tbl2.doc Microsoft Word® Document MS Word® 97 SR-1 42KB 1 page Contents: Table 2. Comparison of prevalence rates for lumbar spinal stenosis presented in three separate studies 008tbl3.doc Microsoft Word® Document MS Word® 97 SR-1 41KB 1 page Contents: Table 3. Longitudinal study of development of spondylolisthesis in older adults 009tbl4.doc Microsoft Word® Document MS Word® 97 SR-1 46KB 4 pages Contents: Table 4. Spinal stenosis in asymptomatic adults 010tbl5.doc Microsoft Word® Document MS Word® 97 SR-1 41KB 1 page Contents: Table 5. Spondylolisthesis in asymptomatic older adults 011fig1.doc Microsoft Word® Document MS Word® 97 SR-1 72KB 1 page Contents: Figure 1. Differential diagnosis of lumbar spinal stenosis 012fig2.doc Microsoft Word® Document MS Word® 97 SR-1 70KB 1 page Contents: Figure 2. Etiology of lumbar spinal stenosis 013fig3.doc Microsoft Word® Document MS Word® 97 SR-1 638KB 1 page Contents: Figure 3. Top view of a normal lumbar vertebra 014fig4.doc Microsoft Word® Document MS Word® 97 SR-1 316KB 1 page Contents: Figure 4. Lateral view of a normal lumbar vertebra 015fig5.doc Microsoft Word® Document MS Word® 97 SR-1 1.2MB 1 page Contents: Figure 5. Oblique view of the normal l3 to l5 lumbar vertebrae 016fig6.doc Microsoft Word® Document MS Word® 97 SR-1 1.3MB 1 page Contents: Figure 6. Pathology associated with lumbar spinal stenosis 017fig7.doc Microsoft Word® Document MS Word® 97 SR-1 1.2MB 1 page Contents: Figure 7. Spondylolisthesis showing entrapment of spinal canal and nerve roots 018fig8.doc Microsoft Word® Document MS Word® 97 SR-1 78KB 1 page Contents: Figure 8. Diagnosis and treatment of lumbar spinal stenosis 019chap2.doc Microsoft Word® Document MS Word® 97 SR-1 91KB 14 pages Contents: Chapter 2. Methodology: Research Questions; Evidence Model; Databases Searched; MESH Terms and Search Strategy; Criteria for Retrieval of Full Articles; Electronic Data Abstraction Forms; Quality of the Literature 020fig9.doc Microsoft Word® Document MS Word® 97 SR-1 80KB 1 page Contents: Figure 9. Evidence model depicting the natural history of lumbar spinal stenosis 021fig10.doc Microsoft Word® Document MS Word® 97 SR-1 44KB 1 page Contents: Figure 10. Evidence model depicting the diagnosis and treatment of lumbar spinal stenosis 022chap3.doc Microsoft Word® Document MS Word® 97 SR-1 294KB 52 pages Contents: Chapter 3. Results: Question 1: What is the relationship between each relevant patient characteristic and the presence and/or intensity of each of the patient signs, symptoms, and conditions of spinal stenosis? Question 2: Which relevant patient characteristics are associated with an increased likelihood of focal narrowing of the spinal canal? Question 3: What is the relationship between degree of stenosis and the presence and/or intensity of each of the signs, symptoms, and patient conditions? Question 4: What is the relationship between the signs and symptoms and other features of the patient history and physical and the results of the imaging examination? Question 5: What is the relationship between the signs and symptoms and other features of the patient history and physical and results of conservative treatment; and what is the relationship between the type of conservative treatment and patient outcomes? Question 6: What is the relationship between the signs, symptoms, and other features of the patient history and physical and the success or failure of surgical treatment? Question 7: What is the relationship between the results of the imaging examination and the success or failure of surgical treatment? Question 8: What is the relationship between the type of surgery received and the success or failure of surgical treatment? Question 9: What costs are associated with nonsurgical and surgical treatment of spinal stenosis? 023tbl6.doc Microsoft Word® Document MS Word® 97 SR-1 57KB 8 pages Contents: Table 6. Spinal measurements in patients with symptoms of stenosis 024tbl7.doc Microsoft Word® Document MS Word® 97 SR-1 43KB 1 page Contents: Table 7. Summary of meta-analysis of differences in spinal canal diameter between patients with and without back pain 025tbl8.doc Microsoft Word® Document MS Word® 97 SR-1 39KB 1 page Contents: Table 8. Binomial effect size display: canal size in patients with and without back pain 026tbl9.doc Microsoft Word® Document MS Word® 97 SR-1 41KB 1 page Contents: Table 9. Summary of meta-analysis of differences in spinal canal diameters of patients with and without claudication 027tbl10.doc Microsoft Word® Document MS Word® 97 SR-1 39KB 1 page Contents: Table 10. Binomial effect size display: canal size in patients with and without claudication 028fig11.doc Microsoft Word® Document MS Word® 97 SR-1 62KB 1 page Contents: Figure 11. Forrest plot of differences in spinal canal diameter in patients with and without back pain 029fig12.doc Microsoft Word® Document MS Word® 97 SR-1 100KB 1 page Contents: Figure 12. Overlap of the distributions of normalized canal diameters in patients with and without back pain 030fig13.doc Microsoft Word® Document MS Word® 97 SR-1 103KB 1 page Contents: Figure 13. Forrest plot of differences in spinal canal diameters in patients with and without claudication 031fig14.doc Microsoft Word® Document MS Word® 97 SR-1 212KB 1 page Contents: Figure 14. Overlap of the distributions of normalized canal measurements in patients with and without claudication 032tbl11.doc Microsoft Word® Document MS Word® 97 SR-1 44KB 2 pages Contents: Table 11. Spinal measurements of patients with stenosis and in control subjects 033tbl12.doc Microsoft Word® Document MS Word® 97 SR-1 41KB 1 page Contents: Table 12. Summary of meta-analysis of differences in canal diameter between patients with and without stenosis 034tbl13.doc Microsoft Word® Document MS Word® 97 SR-1 39KB 1 page Contents: Table 13. Binomial effect size display: canal size in patients with and without stenosis 035fig15.doc Microsoft Word® Document MS Word® 97 SR-1 78KB 1 page Contents: Figure 15. Forrest plot of differences in spinal canal between patients with and without spinal stenosis 036fig16.doc Microsoft Word® Document MS Word® 97 SR-1 46KB 1 page Contents: Figure 16. Overlap between normalized canal measurements in patients with and without stenosis 037tbl14.doc Microsoft Word® Document MS Word® 97 SR-1 39KB 1 page Contents: Table 14. Relationship between back pain and spondylolisthesis 038fig17.doc Microsoft Word® Document MS Word® 97 SR-1 69KB 1 page Contents: Figure 17. Association between percentage of patients reporting neurogenic claudication and the mean number of stenotic levels 039tbl15.doc Microsoft Word® Document MS Word® 97 SR-1 60KB 2 pages Contents: Table 15. Excluded diagnostic imaging studies 040tbl16.doc Microsoft Word® Document MS Word® 97 SR-1 42KB 1 page Contents: Table 16. Diagnostic trials meeting preliminary inclusion criteria 041tbl17.doc Microsoft Word® Document MS Word® 97 SR-1 50KB 2 pages Contents: Table 17. Surgical trials reporting imaging results 042tbl18.doc Microsoft Word® Document MS Word® 97 SR-1 39KB 1 page Contents: Table 18. Regression analysis of treadmill walking distance before and after three months of conservative treatment 043tbl19.doc Microsoft Word® Document MS Word® 97 SR-1 40KB 1 page Contents: Table 19. Mean change in treadmill walking distance before and after three months of conservative treatment stratified by initial status 044tbl20.doc Microsoft Word® Document MS Word® 97 SR-1 40KB 1 page Contents: Table 20. Change category frequencies for treadmill walking distance after three months of conservative treatment stratified by initial status 045tbl21.doc Microsoft Word® Document MS Word® 97 SR-1 39KB 1 page Contents: Table 21. Initial stenotic canal diameter stratified by outcome of conservative treatment 046tbl22.doc Microsoft Word® Document MS Word® 97 SR-1 40KB 1 page Contents: Table 22. Disposition of publications on conservative treatments 047tbl23.doc Microsoft Word® Document MS Word® 97 SR-1 42KB 1 page Contents: Table 23. Analysis of walking capacity data from Fukusaki, Kobayashi, Hara et al., 1998 048tbl24.doc Microsoft Word® Document MS Word® 97 SR-1 44KB 2 pages Contents: Table 24. Randomized controlled trials of patients receiving conservative treatments 049fig18.doc Microsoft Word® Document MS Word® 97 SR-1 90KB 1 page Contents: Figure 18. Initial vs. final walking distance computed from Eskola, Pohjolainen, Alaranta et al., 1992 050fig19.doc Microsoft Word® Document MS Word® 97 SR-1 90KB 1 page Contents: Figure 19. Initial vs. difference in walking computed from Eskola, Pohjolainen, Alaranta et al., 1992 051fig20.doc Microsoft Word® Document MS Word® 97 SR-1 90KB 1 page Contents: Figure 20. Initial vs. ratio of change in walking distance computed from Eskola, Pohjolainen, Alaranta et al., 1992 052tbl25.doc Microsoft Word® Document MS Word® 97 SR-1 53KB 4 pages Contents: Table 25. Controlled trials of patients with lumbar spinal stenosis 053tbl26.doc Microsoft Word® Document MS Word® 97 SR-1 41KB 1 page Contents: Table 26. Analysis of walking capacity in meters from Johnsson, Uden, and Rosen, 1991 054tbl27.doc Microsoft Word® Document MS Word® 97 SR-1 41KB 1 page Contents: Table 27. Analysis of walking capacity according to a three-level scale from Johnsson, Uden, and Rosen, 1991 055tbl28.doc Microsoft Word® Document MS Word® 97 SR-1 44KB 2 pages Contents: Table 28. Controlled trials of patients with lateral lumbar spinal stenosis 056tbl29.doc Microsoft Word® Document MS Word® 97 SR-1 43KB 1 page Contents: Table 29. Analysis of global success data from Kirkaldy-Willis, Wedge, Yong-Hing et al., 1982 057tbl30.doc Microsoft Word® Document MS Word® 97 SR-1 54KB 4 pages Contents: Table 30. Controlled trials of patients with degenerative spondylolisthesis 058tbl31.doc Microsoft Word® Document MS Word® 97 SR-1 55KB 10 pages Contents: Table 31. Trials comparing surgery and conservative therapy 059tbl32.doc Microsoft Word® Document MS Word® 97 SR-1 41KB 1 page Contents: Table 32. Analysis of neurogenic claudication comparing nonsurgical patients to surgical patients from Johnsson, Uden, and Rosen, 1991 060tbl33.doc Microsoft Word® Document MS Word® 97 SR-1 42KB 1 page Contents: Table 33. Analysis of walking capacity in meters comparing nonsurgical patient to surgical patients from Johnsson, Uden, and Rosen, 1991 061tbl34.doc Microsoft Word® Document MS Word® 97 SR-1 48KB 2 pages Contents: Table 34. Effect sizes for one and four year outcomes of patients with moderate symptoms at baseline from Atlas, Deyo, Keller et al., 1996 and Atlas, Keller, Robson et al., 2000 062tbl35.doc Microsoft Word® Document MS Word® 97 SR-1 49KB 2 pages Contents: Table 35. Examiner assessment data from surgically and conservatively treated patients with lumbar spinal stenosis from Amundsen T, Weber H, Nordal HJ et al., 2000 063tbl36.doc Microsoft Word® Document MS Word® 97 SR-1 45KB 1 page Contents: Table 36. Patient reported pain data compared to examiner assessment data from surgically and conservatively treated patients with lumbar spinal stenosis from Amundsen T, Weber H, Nordal HJ et al., 2000 064fig21.doc Microsoft Word® Document MS Word® 97 SR-1 86KB 1 page Contents: Figure 21. Beaujon score from Mariconda, Zanforlino, Celestino et al., 2000 065fig22.doc Microsoft Word® Document MS Word® 97 SR-1 86KB 1 page Contents: Figure 22. Leg pain at exertion score from Mariconda, Zanforlino, Celestino et al., 2000 066fig23.doc Microsoft Word® Document MS Word® 97 SR-1 89KB 1 page Contents: Figure 23. Beaujon score for neurological deficit from Mariconda, Zanforlino, Celestino et al., 2000 067tbl37.doc Microsoft Word® Document MS Word® 97 SR-1 44KB 4 pages Contents: Table 37. Relationship between degree of stenosis and surgical results 068tbl38.doc Microsoft Word® Document MS Word® 97 SR-1 42KB 1 page Contents: Table 38. Analysis of walking capacity data from Thomas, Rea, Pikul et al., 1997 069tbl39.doc Microsoft Word® Document MS Word® 97 SR-1 41KB 1 page Contents: Table 39. Comparison of effect sizes for data on pain relief from Grob, Humke, and Dvorak, 1995 070tbl40.doc Microsoft Word® Document MS Word® 97 SR-1 42KB 1 page Contents: Table 40. Comparison of effect sizes for data on global assessment from Lee and deBari, 1986 071tbl41.doc Microsoft Word® Document MS Word® 97 SR-1 42KB 1 page Contents: Table 41. Effect size for data on global assessment from Fischgrund, Mackay, Herkowitz et al., 1997 072tbl42.doc Microsoft Word® Document MS Word® 97 SR-1 42KB 1 page Contents: Table 42. Effect size for data on global assessment from Herkowitz and Kurz, 1991 073tbl43.doc Microsoft Word® Document MS Word® 97 SR-1 42KB 1 page Contents: Table 43. Effect size for data on back and leg pain from Herkowitz and Kurz, 1991 074tbl44.doc Microsoft Word® Document MS Word® 97 SR-1 43KB 1 page Contents: Table 44. Effect size for data on functional status, back pain, and leg pain from Yuan, Garfin, Dickman et al., 1994 075tbl45.doc Microsoft Word® Document MS Word® 97 SR-1 42KB 1 page Contents: Table 45. Effect size for data on global assessment from Lombardi, Wiltse, Reynolds et al., 1985 076tbl46.doc Microsoft Word® Document MS Word® 97 SR-1 59KB 5 pages Contents: Table 46. Treatment costs for procedures related to lumbar spinal stenosis 077chap4.doc Microsoft Word® Document MS Word® 97 SR-1 53KB 6 pages Contents: Chapter 4. Conclusions 078chap5.doc Microsoft Word® Document MS Word® 97 SR-1 29KB 3 pages Contents: Chapter 5. Future Research: Study Design; Reporting of Patient Characteristics, Signs, and Symptoms; Patient Inclusion Criteria 079tbl47.doc Microsoft Word® Document MS Word® 97 SR-1 44KB 1 page Contents: Table 47. Trial designs, number of patients, and reporting of prior conservative therapy in surgical and conservative treatment trials related to lumbar spinal stenosis 080fig24.doc Microsoft Word® Document MS Word® 97 SR-1 61KB 1 page Contents: Figure 24. Histogram of number of trials reporting patient signs, symptoms, and other characteristics in randomized controlled trials of conservative treatments 081fig25.doc Microsoft Word® Document MS Word® 97 SR-1 65KB 1 page Contents: Figure 25. Histogram of number of trials reporting patient signs, symptoms, and other characteristics in trials of surgical treatments 082fig26.doc Microsoft Word® Document MS Word® 97 SR-1 44KB 1 page Contents: Figure 26. Plot of mean ages and age ranges from 125 studies of lumbar spinal stenosis 083refs.doc Microsoft Word® Document MS Word® 97 SR-1 97KB 13 pages Contents: References 084app.doc Microsoft Word® Document MS Word® 97 SR-1 116KB 38 pages Contents: Appendix: Electronic Data Abstraction Forms 085acro.doc Microsoft Word® Document MS Word® 97 SR-1 20KB 1 page Contents: Selected Acronyms Used in This Report 086v2frt.doc Microsoft Word® Document MS Word® 97 SR-1 26KB 4 pages Contents: Title Page and Table of Contents (Volume 2) 087etb1.doc Microsoft Word® Document MS Word® 97 SR-1 49KB 1 page Contents: Evidence Table 1. Reporting of patient signs, symptoms, and other characteristics related to lumbar spinal stenosis in randomized controlled trials of conservative treatments 088etb2.doc Microsoft Word® Document MS Word® 97 SR-1 285KB 23 pages Contents: Evidence Table 2. Reporting of patient signs, symptoms, and other characteristics related to lumbar spinal stenosis in trials of surgical treatments 089etb3.doc Microsoft Word® Document MS Word® 97 SR-1 53KB 2 pages Contents: Evidence Table 3. Reporting of patient signs, symptoms, and other characteristics related to lumbar spinal stenosis in trials describing only the natural history of lumbar spinal stenosis patients 090etb4.doc Microsoft Word® Document MS Word® 97 SR-1 47KB 1 page Contents: Evidence Table 4. Reporting of outcomes in randomized controlled trials of conservative treatment 091etb5.doc Microsoft Word® Document MS Word® 97 SR-1 233KB 24 pages Contents: Evidence Table 5. Reporting of outcomes related to treatment of lumbar spinal stenosis in trials of surgical treatment 092etb6.doc Microsoft Word® Document MS Word® 97 SR-1 170KB 22 pages Contents: Evidence Table 6. General study design information for clinical trials of patients with lumbar spinal stenosis 093etb7.doc Microsoft Word® Document MS Word® 97 SR-1 166KB 21 pages Contents: Evidence Table 7. Specific study design information for clinical trials of patients with lumbar spinal stenosis 094etb8.doc Microsoft Word® Document MS Word® 97 SR-1 189KB 35 pages Contents: Evidence Table 8. Inclusion and exclusion criteria and comments on study design for clinical trials of patients with lumbar spinal stenosis 095etb9.doc Microsoft Word® Document MS Word® 97 SR-1 226KB 35 pages Contents: Evidence Table 9. Patent treatment information for clinical trials of patients with lumbar spinal stenosis 096etb10.doc Microsoft Word® Document MS Word® 97 SR-1 365KB 37 pages Contents: Evidence Table 10. Patient characteristics information for clinical trials of patients with lumbar spinal stenosis 097etb11.doc Microsoft Word® Document MS Word® 97 SR-1 429KB 36 pages Contents: Evidence Table 11. Patient signs and symptoms for clinical trials of patients with lumbar spinal stenosis 098etb12.doc Microsoft Word® Document MS Word® 97 SR-1 59KB 6 pages Contents: Evidence Table 12. Ability to work outcomes from clinical trials of patients with lumbar spinal stenosis 099etb13.doc Microsoft Word® Document MS Word® 97 SR-1 91KB 15 pages Contents: Evidence Table 13. Back pain outcomes related to treatment of lumbar spinal stenosis 100etb14.doc Microsoft Word® Document MS Word® 97 SR-1 72KB 10 pages Contents: Evidence Table 14. Back pain relief outcomes related to treatment of lumbar spinal stenosis 101etb15.doc Microsoft Word® Document MS Word® 97 SR-1 54KB 4 pages Contents: Evidence Table 15. Disability and dependency outcomes related to treatment of lumbar spinal stenosis 102etb16.doc Microsoft Word® Document MS Word® 97 SR-1 205KB 44 pages Contents: Evidence Table 16. Global success outcomes related to treatment of lumbar spinal stenosis 103etb17.doc Microsoft Word® Document MS Word® 97 SR-1 75KB 10 pages Contents: Evidence Table 17. Leg pain outcomes related to treatment of lumbar spinal stenosis 104etb18.doc Microsoft Word® Document MS Word® 97 SR-1 65KB 7 pages Contents: Evidence Table 18. Leg pain relief outcomes related to treatment of lumbar spinal stenosis 105etb19.doc Microsoft Word® Document MS Word® 97 SR-1 42KB 1 page Contents: Evidence Table 19. Mental status outcomes from clinical trials of patients with lumbar spinal stenosis 106etb20.doc Microsoft Word® Document MS Word® 97 SR-1 60KB 6 pages Contents: Evidence Table 20. Physical function and activities of daily living outcomes related to treatment of lumbar spinal stenosis 107etb21.doc Microsoft Word® Document MS Word® 97 SR-1 47KB 2 pages Contents: Evidence Table 21. Quality of life outcomes related to treatment of lumbar spinal stenosis 108etb22.doc Microsoft Word® Document MS Word® 97 SR-1 98KB 17 pages Contents: Evidence Table 22. Walking capacity outcomes related to treatment of lumbar spinal stenosis 109etb23.doc Microsoft Word® Document MS Word® 97 SR-1 65KB 10 pages Contents: Evidence Table 23. Spinal canal measurements related to low back pain and lumbar spinal stenosis 110etb24.doc Microsoft Word® Document MS Word® 97 SR-1 100KB 22 pages Contents: Evidence Table 24. Complications of surgery related to treatment of lumbar spinal stenosis 111etb25.doc Microsoft Word® Document MS Word® 97 SR-1 118KB 29 pages Contents: Evidence Table 25. Reported co-morbidities of patients with lumbar spinal stenosis 112bib.doc Microsoft Word® Document MS Word® 97 SR-1 120KB 20 pages Contents: Bibliography __________________________________________________________________________________________________________
AHRQ Publication No. 01-E048
Current as of June 2001
Internet Citation:
Treatment of Degenerative Lumbar Spinal Stenosis. File Inventory, Evidence Report/Technology Assessment Number 32. AHRQ Publication No. 01-E048, June 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/stenoinv.htm
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