Lumbar spinal stenosis (LSS) is a condition that occurs when the space surrounding the spinal cord narrows, which puts pressure on this area and leads to low back pain (LBP). LSS is regarded as one of the most common causes of LBP, especially in older adults. Despite this prevalence, the most effective way to manage LSS has not yet been established. Physical therapy is one type of conservative (nonsurgical) treatment that is prescribed for LSS patients. Unfortunately, it's not clear just how effective physical therapy is and if it prevents eventual surgery. To get a better understanding of physical therapy in this context, a study analyzed results from another trial to determine its effectiveness and if it reduced the likelihood of surgery over time.
The initial Spine Patient Outcomes Research Trial (SPORT) evaluated the outcomes for different conservative management strategies by examining 654 LSS patients. Of these, 244 patients had conservative treatment and completed the study, while the others chose to have surgery (357) or dropped out (53). Not all conservative group patients received physical therapy, but clinicians strongly recommended that they consider it. All patients were assessed for health status and disability before the study, and then again 6 weeks, 3 months, 6 months and 1 year later.
Of the 244 conservative group patients, only 90 (37%) received physical therapy during the first six weeks, and there was a wide range of the number of sessions each one attended. Patients who received physical therapy reported significant self-rated improvements, as well as reductions in leg pain and improved physical functioning. Most importantly, 70 of the 244 patients (29%) in the conservative group eventually had surgery, but only 19 (27%) of these received physical therapy in the first six weeks while the remaining 51 (73%) did not. This provides evidence of the benefits of early physical therapy for LSS patients and shows it's associated with a lower rate of surgery over one year. It is therefore advisable to recommend physical therapy to LSS patients in order to improve their condition and reduce their likelihood for surgery.
-As reported in the October '13 edition of The Spine Journal