The NORDSTEN Studies/ The Spinal Stenosis Study

Not Applicable

Active, not recruiting

• Conditions: Lumbar Spinal Stenosis
• Interventions: Procedure: Bilateral laminotomy (BL); Procedure: Unilateral laminotomy with crossover (UL); Procedure: Spinous Process Osteotomy (SPO)

• Registration Number: NCT02007083
• Lead Sponsor: Haukeland University Hospital

Brief Summary

Lumbar Spinal Stenosis (LSS) is a clinical entity were narrowing of the spinal canal gives a compression of the the neural and vascular structures in the spinal canal. This often gives neurogenic claudication and sometimes severe Low Back Pain (LBP). Surgery for LSS is today the most often performed procedure in the adult lumbar spine. Beneficial effect of surgical treatment is well documented by several clinical trials, and a Cochrane review article from 2005 concludes that surgical treatment is superior to non-surgical treatment. The surgical solution is to decompress the stenotic part of the lumbar spine. There is no consensus in the literature of which surgical method that gives best long term clinical results. The investigators are therefore planning a Randomized Controlled Trial, where they will compare clinical and radiological results of three different surgical methods for LSS. The main outcome of this study is to answer which surgical method that gives the best long term clinical results. And, secondary outcome is to find out how much increase of the Dural Sac Cross Sectional Area is needed to give a long time relief of the patients' symptoms.

Detailed Description

Not available

Study Timeline

• Study Start: 2013-11
• Study First Submitted: 2013-11-22
• Study First Submitted QC: 2013-12-05
• Study First Posted: 2013-12-10
• Status Verified: 2020-08
• Last Update Submitted: 2020-08-11
• Last Update Posted: 2020-08-12
• Primary Completion: 2028-10
• Study Completion: 2028-12

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 465

Inclusion Criteria

• have clinical symptoms of spinal stenosis as neurogenic claudication or radiating pain into the bilaterally to the lower limbs, not responding to at least 3 months of conservative treatment.
• Radiological findings corresponding to the clinical symptoms of LSS. Central -stenosis, or lateral recess-stenosis.
• be able to give informed consent and to answer the questionnaires.
• over 18 years of age-have -not responding to at least 3 months of non-surgical treatment.
• be able to understand Norwegian language, spoken and in writing

Exclusion Criteria

• have a degenerative lumbar spondylolisthesis, with a slip ≥ 3 mm verified on standing plain x-rays in lateral view.
• are not willing to give written consent.
• have former surgery in the level of stenosis.
• fracture, or former fusion of the thoracolumbal region.
• cauda equina syndrome (bowel or bladder dysfunction) or fixed complete motor deficit.
• are ASA- classified 4 or 5.
• are older than 80 years
• have a lumbosacral scoliosis more than 20 degrees verified on AP-view
• have distinct symptoms in one or both of their legs due to other diseases, e.g. polyneuropaty, vascular claudication or osteoarthtris.
• LSS in 4 or more levels.
• not able to comply fully with the protocol, including treatment, follow-up or study procedures (psychosocially, mentally and physical).
• the patient is participating in another clinical trial that may interfere with this trial

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Bilateral laminotomy (BL)	Bilateral laminotomy (BL)	The multifidus muscles is detached from the spinous process bilaterally.The decompression of the spinal canal is performed by first doing a flavectomy. Thereby performing a laminotomy (about 1/3) of the the lower part of the superior lamina, and a laminotomy of the upper part (about 1/4) of the inferior lamina. This is performed bilaterally.
Unilateral laminotomy with crossover (UL)	Unilateral laminotomy with crossover (UL)	The multifidus muscles is detached from the spinous process unilaterally. The laminotomy is first performed ipsilaterally. The decompression of the spinal canal is performed by first doing a flavectomy. Then, performing a laminotomy (about 1/3) of the the lower part of the superior lamina, and a laminotomy of the upper part (about 1/4) of the inferior lamina. Dura is then retracted, and the decompression is performed contralaterally.
Spinous process osteotomy (SPO)	Spinous Process Osteotomy (SPO)	The multifidus muscles is detached from the spinous process unilaterally. An osteotomy of the superior spinous process is performed at the basis, in the actual level. The spinous process with intact interspinal and supraspinal ligaments is then retracted to the contralateral side. The decompression is first performed in the midline. Then one goes laterally on both sides too perform the decompression. About 1/3 of the lower part of the superior lamina is removed, and about 1/4 of the upper part of the inferior lamina is removed.

Primary Outcome Measures

Name	Time	Method
Oswestry Disability Index	2, 5 and 10 years after surgery	The investigators will monitor the ODI-index before and after surgery, and calculate the change of ODI after surgery compared to baseline.; The primary outcome is a measurement of the change of ODI (version 2.0) from baseline in the three different surgical groups. This will be done by calculating the mean ODI improvement in each group. The investigators will also compare the proportion of "success patients" between the SPO group, the BL group and the UL group, 24 months after the operation. The investigators will dichotomize the patients, in a "succesful outcome group" and in a "non- succesful outcome group". The threshold value for being categorized as a "succesful outcome" will be computed in a planned study based on data from The Norwegian Registry for Spine Surgery (NORSpine).; The investigators also plan to asses short time results after 2 years, intermediate results after 5 years, and long time results after 10 years.

Secondary Outcome Measures

Name	Time	Method
Zurich claudification Scale, Numeric Rating Scale for leg pain, Numeric Rating Scale for back pain, EQ-5D, and self evaluated effect of surgery.	2, 5 and 10 years after surgery	All of the above mentioned questionaires are validated and reliable questionaires to asses the effect of surgical treatment. The effect of the surgical treatment is calculated by the improvement of the different scores, and thereby is an objective way to asses the effect of the surgical treatment.; The investigators plan to asses short time results after 2 years, intermediate results after 5 years, and long time results after 10 years.

Trial Locations

Locations (1)

Haukeland University Hospital; 🇳🇴 Bergen, Hagevik, Norway