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Picture

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

4/9/2015

3 Comments

 
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
3 Comments
Chad
4/12/2015 05:52:15 am

These studies are great as they make a great case for PT! One thing is interesting about some of the studies I have seen that discuss intervention for patients with stenosis is treating them based on directional preference exercises rather then simply William's Flexion exercises based on their radiographic Dx of "stenosis". I have to admit I did not read this whole study, but I have found that a large amount of patients respond well to DP-exercises, even into extension when they have a Diagnosis of stenosis. For example, if we see a patient that was diagnosed with stenosis 5 years ago via radio, and they just recently began to have back pain it may be irrational to conclude that their bout of back pain is caused from the stenosis.
-Just thought I would get some good discussion going on here, Cheers!

-Chad

Reply
Jim
4/12/2015 10:29:31 am

Chad-

I completely agree. I think seeking a directional preference should always be the treatment of choice. More and more clinicians are using repeated motions as a treatment option, and extension is usually the direction of choice. We tend to spend so much time in flexion that loading into extension is uncomfortable and dysfunctional initially. With repeated loading, symptoms usually subside. Thanks for the great comment.

-Jim

Reply
Mina Maher
9/7/2020 03:36:28 pm

Great study with interesting conclusions..
BUT I want to ask if we could use extension exercises or repeated motions into extension regardless the risk of causing more cord compression and worsen the symptoms or leading to bad complications such as bowel/bladder function ??
It's a very confusing issue

Reply



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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test