One type of low back pain, called lumbar spinal stenosis, is sometimes treated with surgery.But physical therapy works just as well in these cases and with fewer unwanted complications than surgery, according to a study recently published in the journal Annals of Internal Medicine.
In lumbar spinal stenosis, the total space in the lowest part of the spinal canal is reduced.This puts pressure on the spinal cord and nerves located in the area of the lumbar vertebrae, which are the five vertebrae between the chest and pelvis that make up the lower part of the spine.
Spinal stenosis is usually caused by the degeneration of intervertebral discs, ligaments, or the presence of other problems in the joints of the vertebrae.This condition can potentially cause a painful condition. Typical symptoms of spinal stenosis are:
- pain in the groin, buttock and upper thigh that does not extend down the leg (such as sciatica pain)
- pain when standing or walking, which is relieved by sitting or lying down
- pain that worsens in hyperextension of the S.S. (when leaning back) and decreases in S.S. flexion. (when leaning forward).
A procedure known as a decompression or petalectomy is sometimes done to reduce pain in the lumbar spine and surrounding areas.In this, the structures that press on the nerves and cause the symptoms are removed.But physical therapy can also help reduce these symptoms. To compare these two ways of treating the problem, researchers looked at 169 men and women from the Pittsburgh area with lumbar spinal stenosis.All participants agreed to undergo surgery, which half of them underwent immediately, while the rest initially participated in a specially designed physical therapy program.
Participants in both groups were assessed for the first time at 10 weeks, after surgery or the start of physical therapy, respectively. Their pain continued to decrease even 4 months later, while their functionality continued to improve.Two years later, there was no difference in pain or function between participants in the surgery group and those in the physical therapy group. However, 22 participants in the surgery group (25%) experienced complications related to the surgery, such as undergoing a new procedure or developing a surgery-related infection, while 8 of the participants in the physical therapy group (10%) reported worsening of symptoms as a complication.
Choice of treatment
For most people with lumbar spinal stenosis, there are no qualms about choosing the right treatment, especially when they decide to undergo surgery.But the results of this study offer some guidance.
Initially, treatment for lumbar spinal stenosis involves what doctors call conservative measures. These are pain-relieving and anti-inflammatory medications, but also sometimes corticosteroid injections into the lumbar spine. If symptoms don’t improve, surgery is often the next step. This makes sense based on the results of past studies.
But the results of the aforementioned study show that people with lumbar spinal stenosis should first try a well-designed physical therapy program, says Dr. Jeffrey N. Katz, professor of medicine at Harvard Medical School, commenting on the results.If physical therapy does not have the expected results, the decision to submit to surgery should be up to the patient’s preferences, adds Dr. Katz, who is also the author of the study.
Of course, immediate surgery may be needed if there is so much pressure on the nerves that:
muscles around the pelvis or in the lower limbs have lost their functionality
bowel or bladder control and function is difficult
the pain cannot be controlled with medication
When surgery is required, a petalectomy is usually performed.That is, the surgeon removes the bony back part of the vertebra, where the stenosis is located.This makes more room for the nerves exiting the spine. Nowadays, petalectomy can be performed through a tiny incision with the help of modern surgical devices.
Sometimes, however, there is so much narrowing that a simple petalectomy is not enough to treat the problem.In these cases, a petalectomy with spinal fusion may be necessary. That is, apart from removing one or more vertebral arches, the surgeon removes the discs and other surrounding tissues and stabilizes the spine using special materials.
