The long-term clinical course of non-surgically treated lumbar spinal stenosis: a systematic review and meta-analysis

Purpose: Lumbar spinal stenosis (LSS) is a common degenerative spinal condition in older adults. Greater understanding of the long-term clinical course of symptomatic LSS is needed to determine prognosis with non-surgical interventions. This systematic review aimed to model the long-term clinical course of pain and disability in adults with LSS. Methods: The review was prospectively registered (PROSPERO—CRD42024508181). A comprehensive keyword search was completed. Risk of bias was assessed using the Quality In Prognosis Studies tool (QUIPS). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system evaluated the certainty of evidence. Meta-regression analysis was performed to study longitudinal changes in pain (scale 0–10) and disability (sale 0–100). Results: 18 studies were included. Some form of multimodal intervention was most offered (13/18 studies). Pooled mean scores for pain were highest at baseline 5.66 [95% CI 5.15; 6.15] with reductions at 6 months 4.75 [95% CI 4.30; 5.19], 12 months 3.54 [95% CI 2.86; 4.20], and beyond 12 months 4.01 [95% CI 3.43; 4.58]. For disability, the pooled mean score at baseline was 35.07 [95% CI 29.30; 40.83], 26.08 [95% CI 15.51; 36.65] at 6 months, and 25.44 [95% CI 17.99; 32.89] at 12 months. The certainty of evidence for both pain and disability was low. Conclusion: There is low certainty evidence that individuals with LSS experience reductions of up to one-third in pain and disability in the first year after non-surgical intervention. There is little further improvement in pain or disability beyond one-year and up to five years.