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Clinical trials landscape

TL;DR — A live ClinicalTrials.gov v2 query on 2026-08-30 returned 414 records for lumbar spinal stenosis and 57 for degenerative cervical myelopathy; the counts include tangential, completed and nonrandomized studies and are not trial-quality estimates. Current questions span rehabilitation dose, endoscopic versus microscopic decompression, fusion selection, devices, prediction and mild-DCM rehabilitation. Landmark completed trials show why comparator choice matters: steroid plus anesthetic versus anesthetic alone, device versus device, and decompression versus decompression plus fusion answer different questions. Registry status is operational metadata and must be rechecked before use.

Registry method

ClinicalTrials.gov API v2 was queried live by condition on 2026-08-30. Total counts were refreshed and each displayed NCT record was retrieved individually with status, enrollment, dates and intervention fields; NCT identifiers below were written only from those live responses. Condition search is sensitive but not specific, so this page curates decision-relevant examples rather than treating the hit count as epidemiology.

Lumbar rehabilitation

Completed randomized evidence includes comparative nonsurgical care (Schneider 2019, PMID 30646197) and supervised versus home exercise (Minetama 2019, PMID 30986577). Trial design still needs component-level dose, objective walking, long follow-up and crossover to surgery.

Injections and procedures

The 400-person epidural trial used an active anesthetic comparator and found minimal/no added steroid benefit (Friedly 2014, PMID 24988555). Device trials often use another device, while percutaneous decompression may use injection as comparator (Patel 2015, PMID 25494323) (Benyamin 2016, PMID 27228511); none should be read as a universal procedure ranking.

Decompression and fusion

Swedish and NORDSTEN trials directly tested added fusion (Försth 2016, PMID 27074066) (Austevoll 2021, PMID 34347953) (Kgomotso 2024, PMID 39111800). Future trials should enrich for a prespecified instability hypothesis rather than repeat broad unselected comparisons.

DCM trials

Prospective DCM trials have focused on surgical outcomes and adjunctive neuroprotection; riluzole has not become routine (Satin 2022, PMID 36447345) (Fehlings 2024, PMID 38904964). ReMiDY is testing feasibility of rehabilitation in mild stable disease (Treanor 2026, PMID 41667861).

Design failures

Common problems are imaging-only entry criteria, heterogeneous clinical phenotypes, short follow-up, active comparators with uncertain efficacy, nonblinding, crossover, composite success definitions, selective reoperation reporting and outcomes that omit walking or hands.

Research priorities

Trials should stratify lumbar claudication versus radiculopathy, DCM severity and stability, predefine treatment-effect modifiers, include objective mobility and patient-derived outcomes, and publish intervention fidelity. Pragmatic follow-up should capture repeat procedures and total care burden.

Decision table

Registry example Status on 2026-08-30 Question
NCT07588555 Recruiting Two TLIF procedures for single-level LSS
NCT06079580 Completed Balance disorder in LSS
NCT06525896 Active, not recruiting Nonsurgical spinal decompression
NCT06381167 Not yet recruiting Endoscopic vs microscopic decompression
NCT03801356 Terminated Selective root block predicting foraminotomy outcome
NCT02079038 Completed STEPS/Totalis procedure trial
NCT01987622 Completed Acupuncture for LSS
NCT07001969 Enrolling by invitation Percutaneous trans-facet fixation

Evidence map

The table records the page-specific live PubMed retrieval set; inclusion here maps evidence, not endorsement of every intervention.

PMID Year Design Contribution to this page
30646197 2019 randomized trial Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Ste… (Schneider 2019, PMID 30646197)
30986577 2019 randomized trial Supervised physical therapy vs. home exercise for patients with lumbar spinal stenosis: a randomized c… (Minetama 2019, PMID 30986577)
24988555 2014 randomized trial A randomized trial of epidural glucocorticoid injections for spinal stenosis (Friedly 2014, PMID 24988555)
25494323 2015 randomized trial Superion interspinous process spacer for intermittent neurogenic claudication secondary to moderate lu… (Patel 2015, PMID 25494323)
27228511 2016 randomized trial MILD® Is an Effective Treatment for Lumbar Spinal Stenosis with Neurogenic Claudication: MiDAS ENCORE … (Benyamin 2016, PMID 27228511)
27074066 2016 randomized trial A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis (Försth 2016, PMID 27074066)
34347953 2021 randomized trial Decompression with or without Fusion in Degenerative Lumbar Spondylolisthesis (Austevoll 2021, PMID 34347953)
39111800 2024 randomized trial Decompression alone or with fusion for degenerative lumbar spondylolisthesis (Nordsten-DS): five year … (Kgomotso 2024, PMID 39111800)
36447345 2022 review Review of Prospective Trials for Degenerative Cervical Myelopathy (Satin 2022, PMID 36447345)
38904964 2024 randomized trial Riluzole for Degenerative Cervical Myelopathy: A Secondary Analysis of the CSM-PROTECT Trial (Fehlings 2024, PMID 38904964)
41667861 2026 randomized trial ReMiDY (rehabilitation in mild stable degenerative cervical myelopathy): protocol for feasibility rand… (Treanor 2026, PMID 41667861)
36609887 2023 meta-analysis Decompression alone versus decompression with fusion in patients with lumbar spinal stenosis with dege… (Gadjradj 2023, PMID 36609887)
36083346 2022 clinical/observational study [Lumbar spinal stenosis] (Birkenmaier 2022, PMID 36083346)
27745582 2016 review [Lumbar spinal stenosis] (Andresen 2016, PMID 27745582)
36453042 2022 clinical/observational study No need to add fusion to lumbar decompression for stenosis (Azizpour 2022, PMID 36453042)
38945544 2024 randomized trial Decompression alone or decompression with fusion for lumbar spinal stenosis: five-year clinical result… (Karlsson 2024, PMID 38945544)
38444008 2024 cohort study Clinical effects of arthroscopic-assisted uni-portal spinal surgery and unilateral bi-portal endoscopy… (Wang 2024, PMID 38444008)
33627893 2021 clinical/observational study Degenerative Lumbar Spinal Stenosis (Hennemann 2021, PMID 33627893)
17445736 2007 review Lumbar spinal stenosis (Chad 2007, PMID 17445736)
35489687 2023 cohort study Effect of decompression surgery for lumbar spinal stenosis on aerobic capacities during a 6-min walk t… (Gouteron 2023, PMID 35489687)
35334560 2022 review Microendoscopic Lumbar Posterior Decompression Surgery for Lumbar Spinal Stenosis: Literature Review (Suzuki 2022, PMID 35334560)
36763556 2023 clinical/observational study Revision surgery after previous spinal decompression and fusion for lumbar spinal stenosis (Lebedev 2023, PMID 36763556)
36268217 2022 review Comparison of posterior decompression techniques and conventional laminectomy for lumbar spinal stenosis (Zhang 2022, PMID 36268217)
27683714 2016 clinical/observational study A novel strategy of non-fusion instrumentation with coflex interlaminar stabilization after decompress… (Nomura 2016, PMID 27683714)
32613191 2020 guideline/consensus Mobility-Preserving Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations (Roitberg 2020, PMID 32613191)
36266248 2022 review Lumbar Spinal Stenosis: Review Update 2022 (Kwon 2022, PMID 36266248)
38648834 2024 review Lumbar Spinal Stenosis: Diagnosis and Management (Webb 2024, PMID 38648834)
35503342 2022 review Diagnosis and Management of Lumbar Spinal Stenosis: A Review (Katz 2022, PMID 35503342)
37715644 2024 systematic review Exercise treatments for lumbar spinal stenosis: A systematic review and intervention component analysi… (Comer 2024, PMID 37715644)
26727925 2016 systematic review Management of lumbar spinal stenosis (Lurie 2016, PMID 26727925)
26824399 2016 meta-analysis Surgical versus non-surgical treatment for lumbar spinal stenosis (Zaina 2016, PMID 26824399)
35046008 2022 systematic review Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic… (Ammendolia 2022, PMID 35046008)
33857615 2021 guideline/consensus Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical P… (Bussières 2021, PMID 33857615)
35511368 2022 systematic review Efficacy and characteristics of physiotherapy interventions in patients with lumbar spinal stenosis: a… (Temporiti 2022, PMID 35511368)

Interpretation rules

  • Anatomical narrowing is necessary but not sufficient for a symptomatic stenosis diagnosis.
  • Lumbar claudication, lumbar radiculopathy, cervical myelopathy and imaging-only compression are analyzed separately.
  • Absolute changes, confidence intervals and responder proportions outrank within-group significance.
  • Comparator choice determines the question a trial can answer.
  • Reoperation, falls, delirium and recovery burden are outcomes, not footnotes.
  • Subgroup claims require an interaction or externally validated treatment-effect model.
  • Older age is not a contraindication; reserve, goals and modifiable vulnerability are assessed directly.
  • Absence of deterioration in a cohort does not guarantee individual stability.
  • Evidence is research knowledge, not individualized medical advice.

Open questions

  • Which components and doses account for the short-term advantage of individualized manual therapy/exercise over group exercise or medical care? (Schneider 2019, PMID 30646197)
  • Do supervised-exercise responder advantages persist beyond six weeks and reduce later procedure use? (Minetama 2019, PMID 30986577)
  • What is the absolute benefit and harm of epidural injection against sham or no injection, rather than the incremental effect of adding steroid to lidocaine? (Friedly 2014, PMID 24988555)

References

  1. Schneider MJ, et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA network open. 2019;2:e186828. PMID 30646197
  2. Minetama M, et al. Supervised physical therapy vs. home exercise for patients with lumbar spinal stenosis: a randomized controlled trial. The spine journal : official journal of the North American Spine Society. 2019;19:1310-1318. PMID 30986577
  3. Friedly JL, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. The New England journal of medicine. 2014;371:11-21. PMID 24988555
  4. Patel VV, et al. Superion interspinous process spacer for intermittent neurogenic claudication secondary to moderate lumbar spinal stenosis: two-year results from a randomized controlled FDA-IDE pivotal trial. Spine. 2015;40:275-82. PMID 25494323
  5. Benyamin RM, et al. MILD® Is an Effective Treatment for Lumbar Spinal Stenosis with Neurogenic Claudication: MiDAS ENCORE Randomized Controlled Trial. Pain physician. 2016;19:229-42. PMID 27228511
  6. Försth P, et al. A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. The New England journal of medicine. 2016;374:1413-23. PMID 27074066
  7. Austevoll IM, et al. Decompression with or without Fusion in Degenerative Lumbar Spondylolisthesis. The New England journal of medicine. 2021;385:526-538. PMID 34347953
  8. Kgomotso EL, et al. Decompression alone or with fusion for degenerative lumbar spondylolisthesis (Nordsten-DS): five year follow-up of a randomised, multicentre, non-inferiority trial. BMJ (Clinical research ed.). 2024;386:e079771. PMID 39111800
  9. Satin AM, et al. Review of Prospective Trials for Degenerative Cervical Myelopathy. Clinical spine surgery. 2022;35:410-417. PMID 36447345
  10. Fehlings MG, et al. Riluzole for Degenerative Cervical Myelopathy: A Secondary Analysis of the CSM-PROTECT Trial. JAMA network open. 2024;7:e2415643. PMID 38904964
  11. Treanor C, et al. ReMiDY (rehabilitation in mild stable degenerative cervical myelopathy): protocol for feasibility randomized controlled trial. Spinal cord. 2026;64:296-302. PMID 41667861
  12. Gadjradj PS, et al. Decompression alone versus decompression with fusion in patients with lumbar spinal stenosis with degenerative spondylolisthesis: a systematic review and meta-analysis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2023;32:1054-1067. PMID 36609887
  13. Birkenmaier C, et al. [Lumbar spinal stenosis]. Orthopadie (Heidelberg, Germany). 2022;51:943-952. PMID 36083346
  14. Andresen AK, et al. [Lumbar spinal stenosis]. Ugeskrift for laeger. 2016;178. PMID 27745582
  15. Azizpour K, et al. No need to add fusion to lumbar decompression for stenosis. The bone & joint journal. 2022;104-B:1281-1283. PMID 36453042
  16. Karlsson T, et al. Decompression alone or decompression with fusion for lumbar spinal stenosis: five-year clinical results from a randomized clinical trial. The bone & joint journal. 2024;106-B:705-712. PMID 38945544
  17. Wang F, et al. Clinical effects of arthroscopic-assisted uni-portal spinal surgery and unilateral bi-portal endoscopy on unilateral laminotomy for bilateral decompression in patients with lumbar spinal stenosis: a retrospective cohort study. Journal of orthopaedic surgery and research. 2024;19:167. PMID 38444008
  18. Hennemann S, et al. Degenerative Lumbar Spinal Stenosis. Revista brasileira de ortopedia. 2021;56:9-17. PMID 33627893
  19. Chad DA. Lumbar spinal stenosis. Neurologic clinics. 2007;25:407-18. PMID 17445736
  20. Gouteron A, et al. Effect of decompression surgery for lumbar spinal stenosis on aerobic capacities during a 6-min walk test: A preliminary cohort study. Annals of physical and rehabilitation medicine. 2023;66:101673. PMID 35489687
  21. Suzuki A, et al. Microendoscopic Lumbar Posterior Decompression Surgery for Lumbar Spinal Stenosis: Literature Review. Medicina (Kaunas, Lithuania). 2022;58. PMID 35334560
  22. Lebedev VB, et al. Revision surgery after previous spinal decompression and fusion for lumbar spinal stenosis. Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko. 2023;87:70-76. PMID 36763556
  23. Zhang Y, et al. Comparison of posterior decompression techniques and conventional laminectomy for lumbar spinal stenosis. Frontiers in surgery. 2022;9:997973. PMID 36268217
  24. Nomura H. A novel strategy of non-fusion instrumentation with coflex interlaminar stabilization after decompression for lumbar spinal stenosis. Journal of spine surgery (Hong Kong). 2016;2:149-53. PMID 27683714
  25. Roitberg B, et al. Mobility-Preserving Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World neurosurgery: X. 2020;7:100078. PMID 32613191
  26. Kwon JW, et al. Lumbar Spinal Stenosis: Review Update 2022. Asian spine journal. 2022;16:789-798. PMID 36266248
  27. Webb CW, et al. Lumbar Spinal Stenosis: Diagnosis and Management. American family physician. 2024;109:350-359. PMID 38648834
  28. Katz JN, et al. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. 2022;327:1688-1699. PMID 35503342
  29. Comer C, et al. Exercise treatments for lumbar spinal stenosis: A systematic review and intervention component analysis of randomised controlled trials. Clinical rehabilitation. 2024;38:361-374. PMID 37715644
  30. Lurie J, et al. Management of lumbar spinal stenosis. BMJ (Clinical research ed.). 2016;352:h6234. PMID 26727925
  31. Zaina F, et al. Surgical versus non-surgical treatment for lumbar spinal stenosis. The Cochrane database of systematic reviews. 2016;2016:CD010264. PMID 26824399
  32. Ammendolia C, et al. Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review. BMJ open. 2022;12:e057724. PMID 35046008
  33. Bussières A, et al. Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline. The journal of pain. 2021;22:1015-1039. PMID 33857615
  34. Temporiti F, et al. Efficacy and characteristics of physiotherapy interventions in patients with lumbar spinal stenosis: a systematic review. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2022;31:1370-1390. PMID 35511368