What are your spinal stenosis options? Should you have surgery? The past five to 10 years have been tough for some surgeons. Study after study shows that many common surgeries to repair joint or spine problems don’t work when the surgeries are tested against either a fake operation or physical therapy. Recent research conducted in two separate studies demonstrates that invasive spinal stenosis surgery isn’t any better than safe and simple physical therapy.
Spinal stenosis is a condition in which the spinal cord or nerves in the spinal canal located in the middle of the vertebrae get compressed from regular wear and tear, creating bone spurs and enlarged ligaments. The resulting osteoarthritis can cause severe pain in the back and legs when a patient stands, but generally improves when the patient bends forward or switches to a sitting position. This occurs because standing closes off the space for the nerves, while any kind of flexion (bending) opens it up. Most patients who experience pain or weakness in the legs from this condition are treated with invasive spine surgery to widen the space by cutting out the enlarged bone and ligaments. This surgery can have significant side effects, however, with 15 percent to 20 percent of patients reporting complications. About half of these complications are judged to be serious.
Despite the popularity of spinal stenosis surgery, there’s very little scientific evidence that it’s effective. In its January 15, 2015, issue, Spine journal published SPORT (Spine Patient Outcomes Research Trial) a comparison of surgery outcomes with results of patients who chose not to undergo surgery. The results showed that while patients who chose spinal stenosis surgery seemed to fare better for the first few years, by the fourth year the outcomes were identical to those of the patients who didn’t have surgery.
Another study, reported April 7, 2015, in the Annals of Internal Medicine, went one step further by randomizing and assigning spinal-stenosis patients to physical therapy or surgery. The patients were all fairly miserable when they began the study, reporting their pain at a level of seven out of a possible 10, with 10 being maximum pain. Mobility assessments were performed at the 10-week point, at six months, and at one year. Two years after the patients underwent either surgery or physical therapy, they filled out surveys to assess pain, function, and symptoms. The result? In terms of pain relief and improved function, there was no long-term difference between the invasive surgery and physical therapy. Patients who underwent surgery with its accompanying risks experienced no more benefit than the patients who received the much safer physical therapy.
Spinal stenosis can be frightening. Patients often are told by surgeons that they may become paralyzed if they don’t undergo the surgery, and as a result of receiving this information many opt for a big operation with many potentially serious side effects. These two new studies suggest that patients with spinal stenosis may be better off avoiding surgery. Regenerative injections offer a non-invasive alternative for patients with degenerative disc disease who have not been helped by physical therapy and epidurals.
“Spinal Stenosis Options: PT as Effective as Surgery” first appeared as a post on the Regenexx blog.