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RecruitingNCT04552145PTvsSDUpdated Jun 22, 2025

Physical Therapy vs Surgical Decompression for Lumbar Spinal Stenosis

An interventional study of surgery and Physiotherapy in Spinal Stenosis, sponsored by Norwegian University of Science and Technology. Recruiting at 3 sites in Norway. Open to participants aged 50 Years to 80 Years. Per ClinicalTrials.gov, last updated 2025-06-22.

Sponsored by Norwegian University of Science and Technology · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
232
Allocation
Randomized
Ages
50 Years to 80 Years
Sex
All
01

Study summary

This is a randomized controlled multicenter trail comparing physical therapy to surgical decompression in patients with lumbar spinal stenosis. The 0-hypothesis is that there is no difference in the efficacy of structured physical therapy compared to surgical decompression.

Our aim is to evaluate if physical therapy can serve as a nonsurgical alternative for patients with LSS, where the severity of symptoms indicates the need of surgical decompression.

02

Conditions studied

  • Spinal Stenosis

Keywords

  • Surgery
  • Physical Therapy Modalities
03

Who can participate

Ages eligible
50 Years to 80 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Patients describing intermittent neurogenic claudication when walking and symptoms revealed by flexion of the spine.
  • MRI shows lumbar spinal stenosis in one or two levels measured.
  • The duration of the symptoms is longer than six months
  • The patient is a candidate for surgical treatment
  • The patient is capable of physical exercise

Exclusion criteria

Exclusion Criteria:

  • Vascular intermittent claudication
  • Lumbar spinal stenosis in more than two levels
  • Previous low back surgery
  • Symptomatic lumbar disc herniation
  • Degenerative scoliosis with Cobbs angle 30 degrees or more
  • Degenerative spondylolisthesis grade 2 or more
  • Spondylolysis with spondylolisthesis
  • Recent osteoporotic fractures in the spine (last 6 month)
  • Severe symptomatic arthrosis in hip or knee
  • Locally advanced or metastatic cancer
  • ASA >3
  • Polyneuropathy recognized by neurography
  • Insufficient Norwegian language skills
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Investigator, Outcomes assessor)
Enrollment
232 participants (estimated)

Study arms

  • Active comparator
    surgery

    Decompression surgery

    Procedure: surgery

  • Active comparator
    physiotherapy

    Physical therapy program

    Behavioral: Physiotherapy

Interventions

  • Proceduresurgery

    standard decompression surgery

  • BehavioralPhysiotherapy

    3 month physical therapy treatment including home activity based on a well defined program and 4 to 6 visits at physical therapy intervention center.

05

What researchers measure

Primary outcomes

  1. The proportion (%) of patients who improve 30% or more relative to baseline in Oswestry Disability Index 2.1 (ODI)

    Oswestry Disability Index 2.0 (ODI) is the most commonly used condition-specific outcome measure for spinal disorders in general. The score ranges from 0 to 100, with a lower score indicating less severe pain and disability. It has been validated into Norwegian and tested for psychometric properties.

    Time frame: 6 months after index treatment

Secondary outcomes

  1. Patient reported leg pain by Numeric Rating Scale (NRS)

    NRS, scores 0-10, where a higher score indicates more pain

    Time frame: Baseline and 6 months

  2. Patient reported leg pain by Numeric Rating Scale (NRS)

    NRS, scores 0-10, where a higher score indicates more pain

    Time frame: Baseline and 1 year

  3. Patient reported leg pain by Numeric Rating Scale (NRS)

    NRS, scores 0-10, where a higher score indicates more pain

    Time frame: Baseline and 2 years

  4. Patient reported back pain by Numeric Rating Scale (NRS)

    NRS, scores 0-10, where a higher score indicates more pain

    Time frame: Baseline and 6 months

  5. Patient reported back pain by Numeric Rating Scale (NRS)

    NRS, scores 0-10, where a higher score indicates more pain

    Time frame: Baseline and 1 year

  6. Patient reported back pain by Numeric Rating Scale (NRS)

    NRS, scores 0-10, where a higher score indicates more pain

    Time frame: Baseline and 2 years

  7. Walking capacity measured by six-minutes walk-test

    Number of patients improving by 50 m or more after six-minutes walk-test

    Time frame: Baseline and 6 months

  8. Improvement in health-related quality of life

    Measured by EuroQol 5-dimensional 5-level questionnaire (EQ-5D-5L) utility index

    Time frame: Baseline and 1 year, and 2 years after index treatment

  9. Improvement in health-related quality of life

    Measured by EuroQol 5-dimensional 5-level questionnaire (EQ-5D-5L) utility index

    Time frame: Baseline and 2 years

  10. Fraction of patients crossing over from physical therapy to surgical decompression

    We will give the possibility to cross over to surgery 6 months, 1 year, and 2 years after index treatment

    Time frame: 6 months

  11. Fraction of patients crossing over from physical therapy to surgical decompression

    We will give the possibility to cross over to surgery 6 months, 1 year, and 2 years after index treatment

    Time frame: 1 year

  12. Improvement of walking and standing capacity measured with accelerometer

    We will use a body-worn tri-axial lightweight accelerometer (AX3 sensor from Axivity, York, UK) attached by a waterproof tape to the midpoint of the patients' anterior right thigh and at the lower back. Daily physical activity such as walking, running, standing, sitting, lying down and cycling will be monitored. By comparing the continuous activity for one week before treatment, for one week at six-, and 12-month follow-up, we will be able to objectively report about changes in the activity level (25). Since LSS-patients have symptoms while walking and standing, we will report the activity as ratios of walking/standing compare to other activity, as well as summon the three longest walking/standing periods before and after treatment.

    Time frame: Baseline and 6 months

  13. Improvement of walking and standing capacity measured with accelerometer

    We will use a body-worn tri-axial lightweight accelerometer (AX3 sensor from Axivity, York, UK) attached by a waterproof tape to the midpoint of the patients' anterior right thigh and at the lower back. Daily physical activity such as walking, running, standing, sitting, lying down and cycling will be monitored. By comparing the continuous activity for one week before treatment, for one week at six-, and 12-month follow-up, we will be able to objectively report about changes in the activity level (25). Since LSS-patients have symptoms while walking and standing, we will report the activity as ratios of walking/standing compare to other activity, as well as summon the three longest walking/standing periods before and after treatment.

    Time frame: Baseline and 1 year

  14. The proportion (%) of patients who improve 30% or more relative to baseline in Oswestry Disability Index 2.1 (ODI)

    The ODI score ranges from 0 to 100, with a lower score indicating less severe pain and disability.

    Time frame: 1 year after index treatment

  15. The proportion (%) of patients who improve 30% or more relative to baseline in Oswestry Disability Index 2.1 (ODI)

    The ODI score ranges from 0 to 100, with a lower score indicating less severe pain and disability.

    Time frame: 2 years after index treatment

06

Study locations

3 of 3 sites recruiting
  • Innlandet Hospital Trust
    Lillehammer, Norway
    Recruiting
  • Martina Hansen's Hospital
    Oslo, Norway
    • Elisabeth Thornes, md · Contact
    • Nikolaos Ikonomo, md · Contact
    Recruiting
  • St Olavs Hospital
    Trondheim, Norway
    • Sasha Gulati, md phd · Contact
    • Hege Andresen · Contact
    Recruiting
07

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT04552145
Lead sponsor
Norwegian University of Science and Technology
Collaborators
St. Olavs Hospital, Sykehuset Innlandet HF, Martina Hansen's Hospital
Responsible party
Sponsor
First posted
Sep 17, 2020
Start date
Sep 1, 2020
Primary completion
Aug 30, 2026 (estimated)
Completion
Aug 31, 2027 (estimated)
Last update
Jun 22, 2025

Study contacts

Greger Lønne, md phd
Contact
gloenne@me.com
+4797114107
Greger Lønne, md phd
principal investigator · Norwegian University of Science and Technology, Fac MH, INB
Jorunn L Helbostad, phd prof
study director · Norwegian University of Science and Technology, Fac MH, INB

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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