2019丹麦国家临床指南：腰椎管狭窄患者的手术和非手术治疗.pdf

European Spine Journal /10.1007/s00586-019-05987-2 REVIEW ARTICLE Danish national clinical guidelines for surgical and nonsurgical treatment of patients with lumbar spinal stenosis 1 4,5,7 2 2,3 5,7,8 Rikke Rousing  · Rikke Krüger Jensen  · Søren Fruensgaard  · Janni Strøm  · Helle Algren Brøgger  · 6 1 Jørgen Dan Møller Degn  · Mikkel Ø. Andersen Received: 21 December 2017 / Revised: 6 March 2019 / Accepted: 19 April 2019 © The Author(s) 2019 Abstract Purpose To summarize the recommendations from the national clinical guideline published by the Danish Health Authority regarding surgical and nonsurgical interventions in treatment of lumbar spinal stenosis in patients above the age of 65 years. Methods A multidisciplinary working group formulated recommendations based on the GRADE approach. Results Seven of the recommendations were based on randomized controlled trials and three on professional consensus. The guideline recommends surgical decompression for symptomatic lumbar spinal stenosis. Supervised exercise and postsurgical supervised exercise are recommended due to the general benefcial efects of training on general health, even though there was no evidence on an efect on neurogenic pain. The guideline does not recommend manual therapy, paracetamol, NSAIDs, opioids, neurogenic pain medication, muscle relaxants, and decompression combined with instrumented fusion as there was no evidence of the benefcial efect. Conclusion The recommendations are based on low to very low quality of evidence or professional consensu