Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis: A Randomized Trial

This post was shared from OPTIM Manual Therapy Fellowship Facebook page.


Background information:
Lumbar spinal stenosis (LSS) is a pathological condition involving the spinal canal or nerve root foramen. Symptoms often include back pain, leg pain, and numbness and tingling. If the spinal cord is compressed, more severe symptoms include loss of bowel and bladder function. Conservative management (physical therapy) of LSS is inconsistent and highly varied across the country. Currently, surgery remains a popular treatment option for many of these individuals. 

New Study: How Our Practice is Changing! 
Anthony Delitto et al recently published a new article, "Surgery versus Nonsurgical Treatment of Lumbar Spinal Stenosis: A RCT." The study followed 169 patients diagnosed with LSS to see if one intervention proved to be superior to the other at 24-month followup. The conclusion was that each intervention (surgical decompression and PT) yielded similar long-term results. 

What does this mean?  
The impact of this study is huge for PT practice. Lumbar spinal stenosis is a major cause of low back pain in the United States. We now have evidence demonstrating that physical therapy is equally successful as surgical management. These individuals do not always need surgery! The physical therapy interventions included in the study were largely lumbar flexion exercises (posterior pelvic tilts, supine knee-to-chest exercises, quad rocking) and general conditioning exercises. 

Conclusion
More and more evidence is emerging regarding the long term management of many orthopedic conditions. Unfortunately, a large majority of the public has not and will not see this study for several years. Literature takes years to reach the clinic and even longer to reach the patient. We need to start educating patients on the impact of this study today. Next time you are working with a patient with a pathoanatomical diagnosis of lumbar spinal stenosis, discuss with them the long term management of the condition and spend time educating them regarding the pathology. Remember the anatomical problem is usually not causing the movement dysfunction. After performing an appropriate differential diagnosis, let the patient know that physical therapy is the best treatment for their low back dysfunction. 

Please read the entire article to gain more knowledge regarding inclusion criteria, limitations, and statistics that were utilized.

-Jim