Surgical and non surgical outcomes for spinal stenosis are similar after 8 years says a new study
Traditionally, patients with spinal stenosis have been recommended rehabilitation of one sort or another or surgery as a more drastic option if they responded poorly to less invasive methods. Spinal stenosis may lead to neurological claudication, a condition where the nerves of the spine are compromised, affecting the ability to walk and it may even affect bowel habits. The surgical approach is to widen the canal the nerves exist in which in theory should improve the patients quality of life. A smaller subset of patients with stenosis choose spinal manipulation either by manual means or by flexion distraction experience marked improvement, with a much lower level of risk.
As has been discussed before in research papers, the healthcare provider you see first will likely determine what type of rehabilitation provider you see, what your care costs would be and whether or not you have surgery. Most patients who go the medical route first will likely have rehabilitation exercises done and when that does not work, see a pain management specialist and a surgeon as the symptoms worsen. This type of care is expensive, often the progress is slow and many had surgery when their seemed to be little hope of improvement in their quality of life. On the other hand, most patients who consult a chiropractor reported good results, relief of symptoms and a safer long term prognosis.
Since stenosis symptoms are often present with other biomechanical problems, treating the stenosis and the problem area is not the same as treating the mechanical malfunction creating the problem. From the chiropractors perspective, the way the patient walks may be the reason for the pain and the stenosis was a result of a degenerative process caused by their gait.? Would correcting the way the patient walks which improves their balance as they age (a huge problem often ignored in the aged and treated with walkers rather than understanding why they have poor balance) reduce their overall pain, improve their balance and their feeling of wellbeing?
A recent observational study (1) suggested that after several years, those who had surgery did just as well as those who had successful rehabilitation regimens. What this means is that surgery, with all its costs and risks may be no better than rehabilitation, regardless of the theory behind why stenosis surgery was necessary. As we age, the risk of falling increases as well, so gait retraining with the spinal manipulative therapy may be the best solutions for those with spinal stenosis, while their improvement of overall balance will decrease the likelihood of a secondary fracture caused by the loss of balance. This is much more preferable to the use of a walker in those who can benefit from gait retraining.
1. Long-term Outcomes of Lumbar Spinal Stenosis: Eight-Year Results of the Spine Patient Outcomes Research Trial (SPORT)
Lurie, Jon D. MD, MS*,†; Tosteson, Tor D. ScD*,†; Tosteson, Anna ScD*,†; Abdu, William A. MD, MS*,‡; Zhao, Wenyan PhD*,†; Morgan, Tamara S. MA†; Weinstein, James N. DO, MS†,‡