One type of lower back pain, called lumbar spinal stenosis, is sometimes treated with surgery. But physical therapy works just as well, and comes with fewer unwanted complications — some of them life-threatening — than surgery, according to a study published recently in Annals of Internal Medicine.
Stenosis means narrowing. In lumbar spinal stenosis, the space inside the lowest part of the spinal canal has narrowed. This puts pressure on the spinal cord and the nerves extending from the lumbar vertebrae, the five bones between the rib cage and the pelvis that make up the lower part of the spine.
Spinal stenosis usually results from degeneration of discs, ligaments, or any of the joints between the interlocking vertebrae that form the spine (called facet joints). This can cause a painful and potentially disabling narrowing of the spinal canal.
Typical symptoms of spinal stenosis are:
- pain in the groin, buttocks, and upper thigh that does not move down the leg (like the pain of sciatica)
- pain with standing or walking that gets better if you sit or squat
- pain that feels worse when you lean back and becomes less intense 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. But physical therapy can also help ease this type of lower back pain.
To compare these two treatments, researchers recruited 169 Pittsburgh-area men and women with the lower back pain condition 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.
Participants in both groups saw benefits as early as 10 weeks after surgery or beginning physical therapy. Their lower back pain continued to decline over four months, while their physical function continued to improve. 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.
Weighing lower back pain treatment options
For most people with lumbar spinal stenosis, there are no hard and fast rules for choosing the right treatment, especially when deciding whether to have surgery for lower back pain. The results of this study offer some guidance.
Initially, treatment for lumbar spinal stenosis to relieve lower back pain 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 Annals study suggest that people with lumbar spinal stenosis should first try a well-designed physical therapy program, says Dr. Jeffrey N. Katz, professor of medicine at Harvard Medical School, in an editorial commenting on the study results. If physical therapy doesn’t work as well as expected to relieve lower back pain, the decision of when to have surgery should be driven by the person’s preferences, says Dr. Katz, who is also the faculty editor of Back Pain: Finding solutions for your aching back, a Special Health Report from Harvard Health Publishing.
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. The surgeon removes the bony plate (lamina) on the back of the vertebra where the stenosis is located. 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. In addition to removing one or more bony plates, the surgeon removes discs and other tissues, then stabilizes the spine with cement or hardware.
Laminectomy alone is just as effective as spinal fusion, and so is the preferred option when possible to help relieve lower back pain.
Related Information: Back Pain: Finding solutions for your aching back
Below are spiritual recipe for health and wellness: Matthew E. McLaren
Genesis 39:23 The chief jailer did not supervise anything under Joseph’s charge because the LORD was with him; and whatever he did, the LORD made to prosper.
Joshua 1:7 “Only be strong and very courageous; be careful to do according to all the law which Moses My servant commanded you; do not turn from it to the right or to the left, so that you may have success wherever you go.
2 Chronicles 20:20 They rose early in the morning and went out to the wilderness of Tekoa; and when they went out, Jehoshaphat stood and said, “Listen to me, O Judah and inhabitants of Jerusalem, put your trust in the LORD your God and you will be established. Put your trust in His prophets and succeed.”
2 Chronicles 26:5 He continued to seek God in the days of Zechariah, who had understanding through the vision of God; and as long as he sought the LORD, God prospered him.
Ecclesiastes 11:6 Sow your seed in the morning and do not be idle in the evening, for you do not know whether morning or evening sowing will succeed, or whether both of them alike will be good.
Proverbs 16:3 Commit your works to the LORD And your plans will be established.
Esther 8:15 Then Mordecai went out from the presence of the king in royal robes of blue and white, with a large crown of gold and a garment of fine linen and purple; and the city of Susa shouted and rejoiced.
Deuteronomy 29:9 “So keep the words of this covenant to do them, that you may prosper in all that you do.
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