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Can Physical Therapy be as Effective as Surgery for Lumbar Spinal Stenosis?

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Can Physical Therapy be as Effective as Surgery for Lumbar Spinal Stenosis?

A recent study sought to answer this question, and found that physical therapy achieved similar results to surgery in the treatment of lumbar spinal stenosis.

Lumbar spinal stenosis (LSS) is a condition characterized by pain in the lower back and legs, and sometimes numbness and weakness of the legs. People with LSS often have limited standing and walking tolerance due to pressure on nerves as they exit the spine in the lower back. The condition becomes more common with age.

The study, led by Anthony Delitto, PT, PhD, FAPTA and published in the April 2015 issue of Annals of Internal Medicine, was the first to compare a single, evidence-based physical therapy regimen with decompression surgery among patients with spinal stenosis who agreed to be randomly assigned to either approach. In their research report, the authors state that LSS is now the most often cited cause for lumbar surgery in the United States. LSS also happens to be a very common diagnosis that we see in physical therapy.

In a Reuters article about this study, Dr. Delitto said, “Surgery is a riskier procedure, with about a 15% complication rate, and half of those are life-threatening. It isn’t a life-threatening procedure to do physical therapy.”

To show the effectiveness of physical therapy in easing the symptoms of LSS, Delitto and colleagues asked 481 patients if they would be willing to join a study where they would be randomly chosen to proceed with surgery, or receive physical therapy. All of these patients had already been considered to be surgical candidates by a spine surgeon, and had already consented to surgery. Many patients declined to participate in this study to avoid the possibility of being assigned to the non-surgical group. However, 169 patients did participate in the study.

The physical therapy regimen in this study emphasized stretching and general conditioning exercises, as well as patient education in postures to avoid. Patients had the option to crossover from the physical therapy group to the surgery group at any time, or vice versa. Only 2 patients crossed from the surgery group to the physical therapy group. In contrast, 47 patients crossed over from the physical therapy group to the surgery group. In the end, however, no matter which group patients were assigned to, surgery or physical therapy, they had a similar reduction of pain and other symptoms two years after the start of the study.

So is physical therapy as effective as surgery for LSS? The actual answer is, of course, “it depends.” All treatment decisions should be made on a case-by-case basis and the results of any particular research study should not be over-generalized. There are cases of LSS in which compression of nerves or the spinal cord is too severe, and surgery may be necessary to prevent or minimize permanent damage. More often, however, surgery is not immediately imperative, and in these cases, the results of this study suggest that it makes good sense to participate in an active physical therapy program before considering invasive and higher risk interventions such as surgery. If you are suffering from LSS, be sure to openly discuss all your treatment options with your primary care doctor and specialists to help make the best treatment decision for you.

David Kandel, PT, OCS, CSCS

PVHMC Physical Therapist