Surgery isn't always the best route for stenosis. In fact, there's another kind of treatment that might work a lot better for your patient -- physical therapy.
Answering a reader's question, Dr. Anthony L. Komaroff, the doctor behind "Ask Doctor K," a medical column that runs in hundreds of newspapers across the country, noted that many physicians typically start off recommending "conservative treatments" for lumbar spinal stenosis.
These treatments include pain relievers, anti-inflammatory medicines and physical therapy. Other treatments such as corticosteroid injections into the spine can also help, he noted. If pain persists after trying these treatments first, physicians then suggest surgery.
A new study in the Annals of Internal Medicine concluded that physical therapy might actually alleviate spinal stenosis pain as effectively as surgery does. Researchers in the study took a look at 170 people in their late 60s with lumbar spinal stenosis. Participants were randomly assigned to receive either surgery or physical therapy. After two years, the two groups had similar outcomes for pain relief, researchers found.
"Not everyone showed improvement. There was one hitch with this study. More than half of the patients assigned to receive physical therapy decided they wanted surgery, instead. (The study noted that the symptoms of people who chose to have surgery were no different than the symptoms of those who stuck with physical therapy alone.) And a few of the patients assigned to receive surgery decided they wanted physical therapy instead. So the study was not a perfect comparison of physical therapy to surgery," Komaroff noted.
DEAR DOCTOR K: I have painful spinal stenosis in my lower back. My doctor wants me to have surgery, but that seems extreme. Is surgery really my best option?