Surgery Holds No Benefit for Treatment of Spinal Stenosis

A new study reveals that surgical decompression yielded similar effects to a physical therapy (PT) regimen in patients with lumbar spinal stenosis (LSS).

Researchers at the University of Pittsburgh (PA, USA), the University of Utah (Salt Lake City, USA) and other institutions conducted a randomized, controlled study between November 2000 to September 2007, comparing surgical decompression with PT in surgical candidates with LSS aged 50 years or older. A total of 169 participants were randomly assigned (87 to surgery and 82 to PT), with 24-month follow-up completed by 74 and 73 participants in the respective groups. The primary outcome was physical function score at two years, as assessed by masked testers.

The results showed that the mean improvement in physical function for the surgery and PT groups was 22.4 and 19.2, respectively. Intention-to-treat analyses revealed no difference between groups and sensitivity analyses using causal-effects methods to account for the high proportion of crossovers from PT to surgery (57%) showed no significant differences in physical function between groups. Interestingly, most patients did not finish the PT regimen, one-third of the patients failed to complete even half of the regimen, and 16% did not even show for a single treatment. The study was published on April 7, 2015, in Annals of Internal Medicine.

“There are patients who did well in PT, and there are patients who failed with PT; but when we looked across the board at all of those groups, their success and failure rates were about the same,” said lead author physical therapist Anthony Delitto, PhD, chair of the department of physical therapy at the Pitt School of Health and Rehabilitation Sciences (SHRS). “Patients don't exhaust all of their nonsurgical options before they consent to surgery. And physical therapy is one of their nonsurgical options.”

LSS is an anatomical impairment common with aging that is caused by a degenerative narrowing of the spinal canal that puts pressure on the nerve roots, resulting in pain, numbness and weakness through the back and lower extremities. Spinal stenosis most often occurs in adults over 60 years old, and is equally common in men and women.

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