Abstract
BACKGROUND: In this aging population, lumbar spinal stenosis (LSS) reduces walking distance and impairs functionality. The definitive treatment is still controversial. AIM: To assess the efficacy of physical therapy and surgery in improving function and reducing pain levels in patients with LSS, both in the short and long term. METHODS: This prospective study screened patients aged 50-80 years with LSS and divided them into two groups based on certain criteria: Surgical and conservative. The conservative group received a supervised physical therapy and exercise program for 45 minutes, five days a week, for one month. The surgery group underwent micro endoscopic decompression surgery based on their LSS levels. Assessments, conducted before treatment and at one-month and one-year intervals, included the participants' walking distance, pain level using the visual analog scale, functionality using the Istanbul low back pain disability index (ILBDI) and Swiss Spinal Stenosis Questionnaire (SSS) Scale, and activities of daily living level using the Nottingham Extended Activities of Daily Living. RESULTS: The study comprised 40 participants, equally divided into surgical and conservative treatment groups, with no significant demographic differences. After one year, both groups exhibited similar changes in walking distance and pain levels. However, the conservative group demonstrated significantly greater improvements in sub-parameters of functional activity and symptom severity of the SSS. After one year, the surgical group showed greater functionality, as assessed by ILBDI, and superior improvement in activities of daily living compared to the conservative group. CONCLUSION: Both treatments showed comparable efficacy in core outcomes (pain, walking distance). However, complementary advantages were observed: Conservative management demonstrated superior improvement in SSS functional subscales, while surgery yielded greater gains in daily living activities and low-back-pain-related disability.