Monday, January 30, 2023

The short answer is “yes,” however that is because most patients who have been diagnosed with lumbar spinal stenosis have other causes of pain that are amenable to nonsurgical treatment.

Medically speaking, “stenosis” refers to narrowing of a specific channel. Thus, in the case of lumbar spinal stenosis, it is a narrowing of the canal within the lumbar spinal bones that houses the spinal nerves. While spinal stenosis is a congenital issue for some individuals, it is the result of a degenerative process for most that occurs over time and leads to nerve compression. Arthritis of spinal (facet) joints, thickening of ligaments and desiccation of intervertebral discs all contribute to narrowing of the spinal canal(s). When spinal stenosis becomes advanced, pain, weakness and changes in sensation can be experienced. Specifically, lumbar spinal stenosis resembles symptoms of sciatica. It may cause pain that radiates from the low back to the buttocks and legs, as well as weakness and tingling in the lower extremities. Patients can develop a sense of unsteadiness in their gait. Yet, symptoms are also similar to claudication, which is a vascular condition characterized by leg pain with walking. Even so, there are subtle differences. For instance, individuals with lumbar spinal stenosis note that they experience the onset of pain when walking but feel relief when sitting down, and little discomfort when bicycling. They may also report that they feel some sense of relief when walking in a flexed posture, such as leaning forward on a stroller or shopping cart.

While other sources of back pain can result from injury or trauma, spinal stenosis is a progressive and degenerative issue that becomes more significant with age. As changes occur, such as narrowing of the spinal canal, individuals naturally become less active and gradually assume a “hunched over” position.

Non-Surgical Treatment for Spinal Stenosis

We can ask ourselves how any treatment other than surgery can open up a canal that has been narrowed by thickened ligaments and bony overgrowth from arthritic joints. The answer is that only surgery and no other treatment can reverse the narrowing of stenosis as properly defined.

In actuality, most patients who have been diagnosed with lumbar stenosis have another reason for their pain. Although the majority of people over the age of 60 are found to have at least moderate lumbar stenosis on MRI or CAT scanning, the stenosis is not what is primarily bothering them. A careful history and examination often leads to the discovery that a lumbar disc protrusion or myofascial (muscle-based) pain are often contributing to the patient’s symptoms. These conditions are usually amenable to nonsurgical treatments, including ergonomics advice, physical therapy consisting of education, positioning techniques, manual therapy and traction, as well as soft tissue or epidural injections. Medications, although rarely curative, can have a limited role in treatment. Because decreased levels of physical activity can contribute to patients’ disabilities, strengthening and endurance exercises are often employed to reverse these secondary changes. The talented and skillful clinician can determine how to individualize the treatment so that it is often successful.

With a multidisciplinary approach, physiatrists are in an excellent position to identify the specific source of symptoms and develop a targeted treatment plan. Trained as team leaders, physiatrists communicate with other clinicians involved in the patient’s care for the best outcome. Treatment should maximize a patient’s level of functioning—both physically and mentally. Thus, while there is a preliminary focus on reducing pain and establishing a treatment routine, there are options for counseling, as this is a vital component of overall wellness.

By Howard Liss, MD

 Howard Liss, of the Howard Liss, M.D. Rehabilitation Institute, is an assistant clinical professor of rehabilitation medicine at Columbia University. He has offices at the following locations: 177 North Dean, Suite 203, Englewood, NJ 07631, 201 390 9200; 2150 Center Avenue, Suite 1B, Ft. Lee, NJ 07024, 201 820 7610; 3333 Henry Hudson Pkwy, Suite 1L, Riverdale, NY 10463, 718 873 6362. He can be reached at www.lissrehab.com. Call today to schedule an appointment with Dr. Liss.


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