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

Background: Lumbar spinal stenosis (LSS) with neurogenic claudication is a common cause of chronic pain and disability, but the comparative efficacy of nonsurgical interventions remains uncertain. This network meta-analysis evaluated and compared these interventions. Methods: PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) evaluating nonsurgical interventions for LSS with neurogenic claudication. The primary outcome was short-term pain, defined as change in pain intensity from baseline to immediately after treatment. Secondary outcomes included long-term pain (≥6 months after randomization), short- and long-term function, short- and long-term walking distance assessed by walking tests, and short-term response rate. Bayesian random-effects network meta-analyses were performed, and results were reported as mean differences (MDs) with 95% credible intervals (CrIs). Results: Thirty-five RCTs involving 3147 participants were included. Low-certainty evidence indicated that, compared with placebo, acupuncture was associated with clinically important short-term improvements 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 also suggested that acupuncture was associated with clinically important long-term pain reduction and statistically significant improvement in long-term function versus placebo. No other interventions showed clear benefits over placebo for pain or function. No intervention showed clear improvement in walking distance versus placebo or other interventions in the short or long term. All estimates were associated with substantial uncertainty. Conclusion: The evidence was characterized by substantial uncertainty, with certainty ranging from low to very low. Although acupuncture showed potential benefit, the findings remain inconclusive and highlight the need for rigorously designed, high-quality RCTs. Protocol registration: CRD42025649922.