I have spinal stenosis, do I need surgery?
- Posted on: Jun 3 2020
It is believed that ~80% of people will experience some sort of back or neck pain at some point in their lives. Sometimes the pain forces the person to see a doctor who performs an MRI. The results come back and show spinal stenosis. The first question many people ask is, “do I require surgery?” To answer this question, we must first understand the diagnosis.
Spinal stenosis is when the space that is located between the vertebrae that forms the spinal canal begins to narrow. The amount of narrowing can be measured and graded. The lack of space will put pressure on the nerves and can cause pain, numbness/tingling, and muscle weakness. Most commonly, spinal stenosis occurs with the degeneration of the spine from age related diseases, which include loss of water in the discs, osteoarthritis, and repetitive stress causing thickening of the tissue. Tumors and other diseases can also cause stenosis but are less common.
Now let’s look at what the evidence states for surgery versus conservative measures. A study by Delitto et al. found “physical therapy as effective as surgery for degenerative disk disease.” On top of having the same outcomes, “surgery is a riskier procedure, with about a 15% complication rate, and half of those are life-threatening.” Delitto later states in the study that “Those who do not improve and ultimately consider surgery should be informed that the benefits are likely to diminish over time.” In essence, surgery can reduce the tissue currently causing the stenosis but the pain can return over time. This may be caused in part by limitations in a person’s overall functional ability or the inability to fully correct the underlying problem. A Study Lurie et al. stated that surgery offered no benefit over conservative therapy at the 8 year outcomes and 18% of people who had surgery required a second surgery over that time period. This shows that surgery should be the last consideration in correcting stenosis, not the first. The APTA took this a step further and released a statement that “in most cases, symptoms of spinal stenosis can be effectively managed with physical therapy and other conservative treatments. Only the most severe cases of spinal stenosis need surgery or spinal injections.”
Physical therapy is one of the best ways to correct underlying limitations, manage pain, and restore function. Make sure to visit a physical therapist that has had extensive training and experience treating spinal stenosis for the best outcomes.
Delitto A;Piva SR;Moore CG;Fritz JM;Wisniewski SR;Josbeno DA;Fye M;Welch WC; “Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis: A Randomized Trial.” Annals of Internal Medicine, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/25844995/.
Lurie, Jon D. MD, MS; Tosteson, Tor D. ScD; Tosteson, Anna ScD; Abdu, William A. MD, MS; Zhao, Wenyan PhD; Morgan, Tamara S. MA; Weinstein, James N. DO, MS, Long-term Outcomes of Lumbar Spinal Stenosis, Spine: January 15, 2015 – Volume 40 – Issue 2 – p 63-76
“Physical Therapy Guide to Spinal Stenosis.” American Physical Therapy Association, 23 Jan. 2020, www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-spinal-stenosis#.VUEL__DurrQ.
Posted in: Physical Therapy