Back Pain? Physical Therapy vs Surgery for Lumbar Spinal Stenosis

unhappy african american woman suffering from back pain while sitting on sofa near table with digital devices

If you are an aging person with back pain, you may suffer from lumbar spinal stenosis (LSS). This common condition causes pain in the lower back and legs. Back pain can have a serious impact on your quality of life, and many consider surgery to help them relieve their chronic pain and get back to the activities they love. Today, we talk about LSS and your surgical and nonsurgical treatment options.

What is Lumbar Spinal Stenosis?

Spinal stenosis is a condition where your spinal canal narrows, placing pressure on your spinal cord and squeezing your nerves. This pressure can cause pain, weakness, and numbing in the lower back and legs. Oftentimes, the symptoms become noticeable or worsen when you stand for a long time or walk down hills or stairs.

Spinal stenosis usually occurs in the lower part of the spine—the lumbar spine—but it’s possible to have other types of spinal stenosis as well. It also occurs commonly in the neck, which is called cervical stenosis because it affects the cervical spine.

Lumbar spinal stenosis (LSS) develops gradually with age due to regular wear and tear on the back and spine. One of the most common causes of LSS is osteoarthritis, a condition where the cartilage in your joints breaks down. When this happens to the cartilage on your spine, the bones of the spine start rubbing together. This prompts the growth of bone spurs, new bone that can grow into the spinal cord, leaving less room for your nerves.

Because it is a “wear and tear” disease, lumbar spinal stenosis generally occurs in adults over 50. Sometimes, LSS can be related to a spinal injury or other disease in younger people, but this is rare.

What Can I Do to Prevent Lumbar Spinal Stenosis?

In most cases, spinal stenosis is just a natural part of aging. However, evidence suggests that exercising regularly, maintaining a healthy weight, and practicing good posture may help reduce your risk of developing lumbar spinal stenosis.

How is Lumbar Spinal Stenosis Treated?

Treatment for lumbar spinal stenosis varies depending on the severity of the symptoms. There are three main types of treatment:

  1. Exercise and physical therapy
  2. Medication to reduce inflammation
  3. Surgery

Many patients may think that surgery, most commonly a laminectomy, is the best treatment for LSS. A laminectomy involves removing a portion of the vertebrae called the lamina, which allows more room for the spinal cord. However, due to the cost and complications associated with spinal surgery, nonsurgical treatment methods are highly preferred.

In a randomized trial conducted by Dr. Anthony Delitto, patients with lumbar spinal stenosis were treated either with physical therapy or with surgery. After two years, Dr. Delitto found no functional difference between the surgical and nonsurgical groups. Basically, this means that compared to physical therapy, surgery did nothing more to improve the symptoms of patients with LSS.

In a review of over 400 articles published about spinal surgery in 2020, 64.2% of them reported complications. Some of the most common complications and risks include

  • Infection
  • Nerve injury
  • Failure of the bone to heal after surgery
  • Return of symptoms/lack of results

Unlike surgery, which can result in potentially dangerous complications, physical therapy usually yields the same results with none of the risk. Surgery is also often far more costly than physical therapy. Dr. Jeffrey N. Katz, professor of medicine at Harvard Medical School, is just one of the doctors who recommends patients try less intrusive methods of treatment before turning to spinal surgery for LSS.

At Zion Health, we follow the most recent medical research and encourage our members to seek nonsurgical treatments first. Exercise, which can strengthen the back muscles that support the spine and help improve posture, and professional physical therapy (which is shareable with an eligible need) is often enough to drastically reduce symptoms of LSS. Surgery may be the best option in extreme cases of LSS, but the medical literature points to it being used as a last resort when other methods have failed.

What Should I Do if I Experience Symptoms of Lumbar Spinal Stenosis?

If you experience any of the following symptoms of lumbar spinal stenosis, you should talk to your doctor as soon as possible:

  • Lower back pain
  • Pain that extends down the legs
  • Numbness or tingling in the legs
  • Weakness in the legs

Waiting until LSS has gotten too severe makes it much more difficult to treat. Severe LSS can increase pain,  lead to loss of bowel movements, and even cause permanent numbness or paralysis. The good news is that lumbar spinal stenosis is often easy to manage, especially if you talk to your doctor early.

If you need help finding a provider or want direction on how to reach out about LSS symptoms, contact our Medical Advocacy team! They’re here specifically to help find a quality provider for you and negotiate fair costs.

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