Physiotherapy and Surgery produce same results in Lumbar Canal Stenosis: Results of Research by University of Pittsburg, USA:
The University of Pittsburgh study (Surgery Versus Nonsurgical Treatment of
Lumbar Spinal Stenosis: A Randomized Trial), published online in the
Annals of Internal Medicine, found nearly equal success between physical
therapy and decompression surgery for lumbar spinal stenosis, a degenerative
condition that commonly occurs as people age. It is the first study that
clearly compared outcomes between surgery and an evidence-based, standardized
physical therapy approach for lumbar spinal stenosis.
The condition, created by
a narrowing of the spinal canal that puts pressure on the nerve roots resulting
in pain, numbness and weakness through the back and lower extremities, has
caused decompression surgery to become the fastest-growing intervention in
today's older population.
"Surgery is a riskier procedure, with about a 15
percent complication rate, and half of those are life-threatening," said
Dr. Anthony Delitto, chair of physical therapy at the School of Health and
Rehabilitation Sciences at the University of Pittsburgh. "It isn't a
life-risking procedure to do Physical therapy."
Physical therapy may work as well as surgery for easing
symptoms of lumbar spinal stenosis, a common cause of nerve damage and lower
back pain among older people, a study suggests.
"Surgery is a riskier procedure, with about a 15
percent complication rate, and half of those are life-threatening," said
Dr. Anthony Delitto, chair of physical therapy at the School of Health and
Rehabilitation Sciences at the University of Pittsburgh. "It isn't a
life-risking procedure to do physical therapy."
Lumbar spinal stenosis, a compression of open spaces in the
lower spinal column, can lead to pinched nerves, tingling, weakness and
numbness in the back and the lower extremities. The condition becomes more
common with age, and an estimated 2.4 million Americans may have it by 2021,
according to the American Academy of Orthopedic Surgeons.
Delitto and colleagues set out to see if they could show
that physical therapy, long known to be safer than surgery, could work as well
as at easing symptoms.
Between 2000 and 2005, they asked 481 patients who consented
to surgery if they would be willing to join a study where they would be
randomly chosen to proceed with the operation or receive physical therapy. Most
declined, to avoid being assigned to the non surgical group, but 169 patients
agreed to participate in the experiment.
Ultimately, 87 patients had surgery and 82 were assigned
physical therapy.At the start of the study, patients were at least 50 years
old. They had to be able to walk at least a quarter mile without difficulty and
have no underlying medical conditions such as dementia, severe vascular
disease, cancer, or a prior heart attack.
Most of them were sedentary or only mildly active, and they
were typically obese. Patients in the surgery group were slightly younger,
about 67 on average, compared with an average age of about 70 for patients
receiving physical therapy.
The physical therapy regimen consisted of twice-weekly
rehabilitation sessions for six weeks. Participants were allowed to opt out of
this regimen in favor of surgery at any point during the study, and over an
average two years of follow-up 47 of them, or 57 percent, did just that.
No matter what group they started in, participants achieved
similar reduction of pain and other symptoms at two years.
"The study demonstrates that both surgery and physical
therapy are reasonable choices; the person who goes down either path ends up in
the same place a year or two later," said Dr. Jeffrey Katz, director of
the Orthopedic and Arthritis Center for Outcomes Research at Brigham and
Women's Hospital in Boston.
Katz, who wrote an editorial accompanying the study in
Annals of Internal Medicine, noted that there's still a role for surgery in
treating lumbar spinal stenosis. But there's no harm in trying physical therapy
first, he said.
Because so many eligible patients opted not to participate
in the study, and so many randomly selected for physical therapy abandoned it
to get surgery, more research may still be needed in a larger group of patients
to get a complete picture of the relative benefits of each option, said Dr.
James Weinstein, chief executive of Dartmouth-Hitchcock health system, who
wasn't involved in the study.
Still, "surgery should be the last option," said
Weinstein, lead author of a 2008 paper in the New England Journal of Medicine
that found surgery more effective at curbing symptoms than non surgical
alternatives.
Despite the small size of the current study and the number
of patients who stopped physical therapy early, it still makes sense to try it
before surgery, said Dr. Richard Deyo, a researcher in back pain at Oregon
Health and Science University, in email to Reuters Health.
"If they elect to have surgery at a later time, the
results appear to be as good as for patients who choose earlier surgery,"
said Deyo, who wasn't involved in the study. "Some patients are inclined
toward surgery because the high tech approach seems more definitive,
attractive, and quicker. However, patients should realize they are likely to
need physical therapy even after successful surgery, and recovery can be
slow."
5. Surgery Versus
Nonsurgical Treatment of Lumbar Spinal Stenosis: A Randomized Trial: http://annals.org/article.aspx?articleid=2214174
