{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T16:17:49Z","timestamp":1759421869775},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The aim of this study was to obtain an unbiased causal treatment estimate of the between-group difference of surgery versus nonoperative treatment with respect to outcomes on quality of life, pain, and disability in patients with degenerative lumbar spinal stenosis (DLSS) 12 months after baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors included DLSS patients from a large prospective multicenter observational cohort study. Propensity score matching was used, including 15 demographic, clinical, and MRI variables. Linear and logistic mixed-effects regression models were applied to quantify the between-group treatment effect. Unmeasured confounding was addressed in a sensitivity analysis, assessing the robustness of the results.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 408 patients were included in this study, 222 patients after matching, with 111 in each treatment group. Patients with nonoperative treatment had lower quality of life at the 12-month follow-up (\u22126.21 points, 95% CI \u22129.93 to \u22122.49) as well as lower chances of reaching a minimal clinically important difference in Spinal Stenosis Measure (SSM) symptoms (OR 0.26, 95% CI 0.13 to 0.53) and SSM function (OR 0.26, 95% CI 0.14 to 0.49), than patients undergoing surgery. These results were very robust in case of unmeasured confounding. The surgical complication rate was low; 5 (4.5%) patients experienced a durotomy during intervention, and 5 (4.5%) patients underwent re-decompression.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The authors used propensity score matching to assess the difference in treatment efficacy of surgery compared with nonoperative treatment in elderly patients with DLSS. This study delivers strong evidence that surgical treatment is superior to nonoperative treatment. It helps in clinical decision-making, especially when patients suffer for a long time, sometimes over many years, hoping for a spontaneous improvement of their symptoms. In light of these new results, the number of years with disability can hopefully be reduced by providing adequate treatment at the right time for this ever-growing elderly and frail population.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.1.spine181098","type":"journal-article","created":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T20:03:12Z","timestamp":1554840192000},"page":"185-193","source":"Crossref","is-referenced-by-count":6,"title":["What is the treatment effect of surgery compared with nonoperative treatment in patients with lumbar spinal stenosis at 1-year follow-up?"],"prefix":"10.3171","volume":"31","author":[{"given":"Ulrike","family":"Held","sequence":"first","affiliation":[{"name":"Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich;"},{"name":"Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johann","family":"Steurer","sequence":"additional","affiliation":[{"name":"Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Pichierri","sequence":"additional","affiliation":[{"name":"Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria M.","family":"Wertli","sequence":"additional","affiliation":[{"name":"Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich;"},{"name":"Division of General Internal Medicine, Bern University Hospital, Bern University, Bern;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mazda","family":"Farshad","sequence":"additional","affiliation":[{"name":"Spine Division, Balgrist University Hospital, Zurich;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Brunner","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Zurich;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roman","family":"Guggenberger","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7ois","family":"Porchet","sequence":"additional","affiliation":[{"name":"Spine Unit, Department of Orthopedic Surgery and Neurosurgery, Schulthess Clinic, Zurich; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tam\u00e1s F.","family":"Fekete","sequence":"additional","affiliation":[{"name":"Spine Unit, Department of Orthopedic Surgery and Neurosurgery, Schulthess Clinic, Zurich; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Urs D.","family":"Schmid","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stadtspital Triemli, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaac","family":"Gravestock","sequence":"additional","affiliation":[{"name":"Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob M.","family":"Burgstaller","sequence":"additional","affiliation":[{"name":"Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Oxf Bull Econ Stat","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1111\/1468-0084.00211","article-title":"Bounding a matching estimator: the case of a Norwegian training program","volume":"63","author":"Aakvik A","year":"2001","unstructured":"Aakvik A: Bounding a matching estimator: the case of a Norwegian training program. 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