Comparative Clinical Outcomes of Non-surgical and Surgical Treatment Methods for Lumbar Canal Stenosis: A Systematic Review.

Lumbar canal stenosis (LCS) is a common degenerative spinal disorder that causes narrowing of the spinal canal, leading to low back pain, radicular symptoms, neurogenic claudication, impaired walking ability, and reduced quality of life. This systematic review aimed to compare the clinical outcomes of non-surgical and surgical treatment methods for patients with LCS. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar for studies published between 2005 and 2026. Following PRISMA 2020 guidelines, 22 studies met the inclusion criteria, comprising randomized controlled trials, cohort studies, retrospective studies, and secondary analyses. Eleven studies evaluated non-surgical interventions, including physiotherapy, exercise therapy, manual therapy, multimodal rehabilitation, and acupuncture, while 11 studies assessed surgical interventions, including decompression surgery, endoscopic decompression, fusion procedures, and interspinous devices. Among the 22 included studies, 19 reported clinical outcomes, of which 16 demonstrated significant improvements in pain, disability, walking capacity, and functional status. Seven non-surgical studies reported reductions in pain and disability with improved walking performance following physiotherapy, exercise, manual therapy, multimodal rehabilitation, or acupuncture. Eight surgical studies demonstrated clinically meaningful improvements in pain relief, functional status, and walking ability, with comparative studies consistently favoring surgical treatment over conservative management for short- and long-term outcomes. Non-surgical interventions were effective in reducing symptoms and enhancing quality of life, particularly in patients with mild-to-moderate disease severity. However, surgical decompression generally produced greater and more durable improvements in pain relief, functional recovery, and walking ability, especially among patients with persistent neurogenic claudication or inadequate response to conservative management. Endoscopic decompression offered additional advantages of reduced blood loss and faster postoperative recovery, whereas fusion surgery showed no significant benefit over decompression alone. Overall, the evidence suggests that both treatment modalities have important roles in the management of LCS, with treatment selection depending on symptom severity, functional impairment, patient preferences, and clinical presentation. Several studies reported greater and more sustained improvements following surgical intervention; however, substantial heterogeneity among the included studies limits definitive conclusions regarding comparative effectiveness. Conservative management remains an important first-line treatment option, while surgical intervention may be beneficial for appropriately selected patients.