Nonoperative treatment approaches for patients with lumbar spinal stenosis seen as safe, effective
ORLANDO, Fla. — Various nonoperative treatment approaches were safe and efficacious for patients with lumbar spinal stenosis, according to a presenter at the North American Spine Society.
Michael J. Schneider, DC, PhD, and colleagues randomized 259 patients with lumbar spinal stenosis to be treated with either medical care, non-specific group exercises or a combination of manual therapy and rehabilitation exercises for 6 weeks. At baseline, 2 months and 6 months, the Swiss spinal stenosis questionnaire was used to assess symptom severity and the self-paced walking test was used to assess walking performance.
None of the treatment groups reported serious adverse events. Patients treated with both manual therapy and rehabilitation exercise had a statistically significant decrease in the mean Swiss spinal stenosis score compared with patients in the other groups. The combined manual therapy and rehabilitation exercise group also improved the most with regard to mean walking distance in meters; however, the differences were not statistically significant. There was no difference between the groups with regard to mean amount of daily physical activity.
Results from the responder analysis showed a greater proportion of patients treated with combined manual therapy and rehabilitation exercise improved by more than 30% for the Swiss spinal stenosis score and self-paced walking test score. Physical activity was not different between the groups.
“[The] walking performance seemed to be the most responsive measure, not so much symptoms,” Schneider said. “Within group improvement at 6 months was sustained, but between-group differences were not that great. The manual therapy and individualized exercise seemed to be the most responsive in the short run and the group exercise seemed to increase the physical a little bit more compared to the other groups.”
He continued, “I would choose all three [approaches]. I think blending these approaches together is the best thing.”– by Monica Jaramillo
Schneider MJ, et al. Paper #101. Presented at: North American Spine Society Annual Meeting; Oct. 25-28, 2017; Orlando, Fla.
Disclosure: Schneider reports he is a consultant for NCMIC and State Farm Insurance; has speaking and/or teaching arrangements with NCMIC; receives research support from NIH and PCORI; and receives grants from NIH/NCCAM and PCORI.