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New Guidelines Issued for Lumbar Spinal Stenosis

Surgery superior to pharmacologic treatment in patients with severe disease

MONDAY, April 14 (HealthDay News) -- New clinical guidelines for the diagnosis and treatment of degenerative lumbar spinal stenosis issued by the North American Spine Society (NASS) provide clinicians with the latest evidence-based recommendations for delivering optimal care to patients with the spinal disorder. The guidelines are published in the March/April issue of the Spine Journal.

William C. Watters III, M.D., of Bone and Joint Clinic of Houston, together with the Spinal Stenosis Work Group of the NASS Clinical Guidelines Committee, reviewed current evidence informing the diagnosis and treatment of the disorder.

The guidelines recommend MRI as the most appropriate non-invasive test for diagnosis, with computed tomography myelography useful in patients with contraindications to MRI. In terms of treatment, the guidelines state that there is insufficient evidence to show long-term benefit of pharmacologic therapy. In addition, evidence is insufficient to show overall benefit of physical therapy and spinal manipulation. While epidural steroid injections likely provide short-term relief, evidence is conflicting regarding long-term benefit. In patients with moderate to severe symptoms, surgery is more effective than medical/interventional treatments.

The authors write that "evidence-based clinical guidelines have the potential to improve the appropriateness and effectiveness of patient care by basing this care on the best evidence available."

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