Nonsurgical interventions for lumbar spinal stenosis with neurogenic claudication: A systematic review and network meta-analysis.

Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back that causes leg pain and difficulty walking, affecting many older adults. Researchers reviewed 35 clinical trials involving over 3,000 people to compare different nonsurgical treatments for this condition, including acupuncture, injections, physical therapy, and medications.

The study found that acupuncture showed promise for reducing pain and improving function compared to placebo treatments. In the short term (immediately after treatment), people receiving acupuncture experienced meaningful reductions in both pain levels and disability. The analysis also suggested acupuncture might provide long-term pain relief lasting six months or longer. No other treatments clearly outperformed placebo for pain or functional improvement.

However, the researchers emphasized important limitations. The quality of evidence was low to very low, meaning the results are uncertain and should be interpreted cautiously. None of the treatments studied, including acupuncture, showed clear improvements in walking distance, which is a key concern for people with spinal stenosis. The studies varied considerably in how they were designed and conducted, making firm conclusions difficult.

What this means for patients: While acupuncture appears to be a potentially helpful option for managing pain and improving daily function in lumbar spinal stenosis, more high-quality research is needed before drawing definitive conclusions. If you're considering acupuncture, discuss it with your healthcare provider to determine if it's appropriate for your specific situation. If you decide to try acupuncture, seek treatment from a licensed and qualified acupuncture practitioner with experience treating spinal conditions.

This systematic review and network meta-analysis evaluated nonsurgical interventions for lumbar spinal stenosis with neurogenic claudication, analyzing 35 RCTs with 3,147 participants. Using Bayesian random-effects models, researchers assessed short-term pain as the primary outcome, with secondary outcomes including long-term pain (≥6 months), function, and walking distance.

Results showed low-certainty evidence that acupuncture produced clinically important short-term improvements versus placebo in pain (MD -10.02, 95% CrI -18.49 to -0.23) and function (MD -14.39, 95% CrI -25.26 to -3.69). Pairwise meta-analysis suggested acupuncture also provided clinically meaningful long-term pain reduction and statistically significant functional improvement. No other interventions demonstrated clear superiority over placebo for pain or function, and no treatment improved walking distance significantly.

Clinical implications: While acupuncture shows potential benefit for LSS-related pain and disability, substantial uncertainty and low-to-very-low certainty evidence warrant cautious interpretation. These findings support considering acupuncture as part of multimodal management but emphasize the need for higher-quality RCTs to establish definitive treatment recommendations.