SUcceSS, SUrgery for Spinal Stenosis: Protocol of a randomised, placebo-controlled trial

David B. Anderson, Manuela L. Ferreira, Ian A. Harris, Gavin A. Davis, Ralph Stanford, David Beard, Qiang Li, Stephen Jan, Ralph J. Mobbs, Christopher G. Maher, Renata Yong, Tara Zammit, Jane Latimer, Rachelle Buchbinder

Research output: Contribution to journalArticleOtherpeer-review

Abstract

Introduction: Central lumbar spinal stenosis (LSS) is a common cause of pain, reduced function and quality of life in older adults. Current management of LSS includes surgery to decompress the spinal canal and alleviate symptoms. However, evidence supporting surgical decompression derives from unblinded randomised trials with high cross-over rates or cohort studies showing modest benefits. This protocol describes the design of the SUrgery for Spinal Stenosis (SUcceSS) trial-the first randomised placebo-controlled trial of decompressive surgery for symptomatic LSS. Methods and analysis: SUcceSS will be a prospectively registered, randomised placebo-controlled trial of decompressive spinal surgery. 160 eligible participants (80 participants/group) with symptomatic LSS will be randomised to either surgical spinal decompression or placebo surgical intervention. The placebo surgical intervention is identical to surgical decompression in all other ways with the exception of the removal of any bone or ligament. All participants and assessors will be blinded to treatment allocation. Outcomes will be assessed at baseline and at 3, 6, 12 and 24 months. The coprimary outcomes will be function measured with the Oswestry Disability Index and the proportion of participants who have meaningfully improved their walking capacity at 3 months postrandomisation. Secondary outcomes include back pain intensity, lower limb pain intensity, disability, quality of life, anxiety and depression, neurogenic claudication score, perceived recovery, treatment satisfaction, adverse events, reoperation rate and rehospitalisation rate. Those who decline to be randomised will be invited to participate in a parallel observational cohort. Data analysis will be blinded and by intention to treat. A trial-based cost-effectiveness analysis will determine the potential incremental cost per quality-adjusted life year gained. Ethics and dissemination: Ethics approval has been granted by the NSW Health (reference:17/247/POWH/601) and the Monash University (reference: 12371) Human Research Ethics Committees. Dissemination of results will be via journal articles and presentations at national and international conferences.

Original languageEnglish
Article numbere024944
Number of pages9
JournalBMJ Open
Volume9
Issue number2
DOIs
Publication statusPublished - 13 Feb 2019

Keywords

  • lumbar spinal stenosis
  • placebo controlled trial
  • randomised controlled trial

Cite this

Anderson, D. B., Ferreira, M. L., Harris, I. A., Davis, G. A., Stanford, R., Beard, D., ... Buchbinder, R. (2019). SUcceSS, SUrgery for Spinal Stenosis: Protocol of a randomised, placebo-controlled trial. BMJ Open, 9(2), [e024944]. https://doi.org/10.1136/bmjopen-2018-024944