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Conservative Treatment for Spinal Stenosis
The Study: A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study.
It is widely believed that spinal stenosis can be treated with non-surgical methods.
b. This is a prospective consecutive case series with a follow up which looks at cases with radiculopathy secondary to lumbar spinal stenosis.
c. Patients were excluded if they had any of the following: radiculopathy by other causes than stenosis, claudication symptoms of vascular origin, systemic illness, contraindications to treatments used in the study, not able to communicate in English or worker’s compensation or personal injury cases.
d. The time period and frequency for treatment was determined by the clinician and therefore varied, but was generally 2 to 3 times a week for 3 weeks. At that time a re-examination was conducted following which treatment frequency was typically reduced to 1 or 2 times per week. Some patients were deemed to be well sooner and were released following the re-examination or in the three weeks following the re-examination.
e. Disability was evaluated using the Roland Morris Disability Questionnaire and pain intensity was measured using the Three Level Numerical Rating Scale. Patients also rated their “perceived percentage improvement”.
f. The mean time to follow these patients was 16.5 months.
g. The mean improvement in perceived disability from the baseline at the start to the end of the follow up was 75.6%.
h. Of the 57 patients in the study only two required surgery.
i. The primary type of care administered to the patients was: Cox distraction manipulation, neural mobilization and exercises.
Take Home: Conservative care may help patients suffering from spinal stenosis.
While the authors noted that while Cox distraction methods were used that other forms of chiropractic manipulation were also thought to be helpful in lumbar spinal stenosis cases. I hope the success of this study will prompt other researchers to look at other forms of chiropractic care for these types of cases.
Non-Surgical Treatment for Spinal Stenosis
The Study: A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study.
The Facts:
a. It is widely believed that spinal stenosis can be treated with non-surgical methods.
b. This is a prospective consecutive case series with a follow up which looks at cases with radiculopathy secondary to lumbar spinal stenosis.
c. Patients were excluded if they had any of the following: radiculopathy by other causes than stenosis, claudication symptoms of vascular origin, systemic illness, contraindications to treatments used in the study, not able to communicate in English or worker’s compensation or personal injury cases.
d. The time period and frequency for treatment was determined by the clinician and therefore varied, but was generally 2 to 3 times a week for 3 weeks. At that time a re-examination was conducted following which treatment frequency was typically reduced to 1 or 2 times per week. Some patients were deemed to be well sooner and were released following the re-examination or in the three weeks following the re-examination.
e. Disability was evaluated using the Roland Morris Disability Questionnaire and pain intensity was measured using the Three Level Numerical Rating Scale. Patients also rated their “perceived percentage improvement”.
f. The mean time to follow these patients was 16.5 months.
g. The mean improvement in perceived disability from the baseline at the start to the end of the follow up was 75.6%.
h. Of the 57 patients in the study only two required surgery.
i. The primary type of care administered to the patients was: Cox distraction manipulation, neural mobilization and exercises.
Dr. Lane says: Conservative (meaning, chiropractic) care may help patients suffering from spinal stenosis.
Reviewer’s Comments: The authors noted that while Cox distraction methods were used that other forms of manipulation were also thought to be helpful in lumbar spinal stenosis cases. I hope the success of this study will prompt other researchers to look at other forms of chiropractic care for these types of cases.
Reference: Murphy DR, Hurwitz EL, Gregory AA, Clary R. A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study. BMC Musculoskelet Disord. 2006 23;7:16.
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