One type of lower back pain, called lumbar spinal stenosis, is sometimes treated with surgery. Physical therapy works just as well, and comes with fewer unwanted complications. Stenosis is a narrowing of space, and lumbar spinal stenosis that space is the spinal canal. This puts pressure on the spinal cord and the nerves extending from the lumbar vertebrae (the lowest five or the “low back” bones. Spinal stenosis usually results from degeneration of discs, ligaments, or any of the joints between the interlocking joints of the spine. This can cause a painful and potentially disabling narrowing of the spinal canal.
Some typical symptoms of spinal stenosis are:
- pain in the groin, buttocks, and upper thigh that does not move down the leg
- pain with standing or walking that gets better if you sit
- pain that feels worse when you lean back and lessens if you lean forward.
An operation known as decompression or laminectomy is sometimes done to ease the pain of lumbar spinal stenosis. It removes structures that are pressing on the nerves and contributing to symptoms, physical therapy can also help ease this type of lower back pain.
To compare these two treatments, researchers recruited 169 men and women with lumbar spinal stenosis. All agreed to have surgery, and understood that half would get surgery right away, while half would initially participate in a specifically designed physical therapy program. Two years later, there was no difference in pain or physical function between the surgery and physical therapy groups.
Twenty-two participants in the surgery group (25%) experienced surgery-related complications like repeat surgery or a surgery-related infection, while eight of those in the physical therapy group (10%) reported worsening symptoms as a complication.
Initially, treatment for lumbar spinal stenosis includes what doctors call conservative measures. These include pain relievers, anti-inflammatory medicines, and sometimes corticosteroid spinal injections. If symptoms don’t improve, surgery is often the next step. That makes sense based on the results of earlier studies.
The results of the new study suggest that people with lumbar spinal stenosis should first try a well-designed physical therapy program. If physical therapy doesn’t work as well as expected, the decision of when to have surgery should be driven by the person’s preferences.
Of course, immediate surgery may be needed if there is so much pressure on the nerves that
• muscles around the pelvis or upper legs become weak
• it becomes difficult to control bladder or bowel function
• pain can’t be controlled with strong medicine.
When surgery is needed, the operation performed is usually a laminectomy. This opens up more space for the spinal nerves. Laminectomy can be performed through a tiny incision and guided by video from a miniature camera. Sometimes there is so much narrowing that a simple laminectomy won’t do the job. In such cases, a laminectomy with spinal fusion may be needed.
