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Surgically treated patients (except changers) performed significantly better in all clinical outcome measures (p less then 0.001) with a plateau at 12-month follow-up staying constant until the follow-up ended. Further, two thirds of patients in the surgical group had a relevant improvement in function, symptoms, and quality of life, compared to only about half of those in terms of symptoms and even less in terms of function and quality of life with non-surgical treatment. CONCLUSIONS Surgical treatment of DLSS results in more favorable