Physical Therapy as Good as Surgery and Less Risky for One Type of Lower Back Pain

A study featured in the Annals of Internal Medicine highlights lumbar spinal stenosis, a form of lower back pain often addressed through surgery. However, the research indicates that physical therapy yields comparable results with fewer associated complications, some of which may be life-threatening. Lumbar spinal stenosis involves the narrowing of the space within the lower part of the spinal canal, exerting pressure on the spinal cord and nerves extending from the lumbar vertebrae. The condition typically arises from disc, ligament, or facet joint degeneration, leading to painful and potentially disabling spinal canal constriction.

Common symptoms of lumbar spinal stenosis encompass pain in the groin, buttocks, and upper thigh, which does not radiate down the leg like sciatica pain. Pain may intensify with standing or walking but alleviate with sitting or squatting, worsening when leaning back and improving with forward-leaning. While surgical interventions such as decompression or laminectomy are occasionally employed to alleviate lumbar spinal stenosis, the study suggests that physical therapy is a viable alternative for mitigating this type of lower back pain.

In the research, 169 individuals from Pittsburgh with lumbar spinal stenosis consented to surgery, with half undergoing immediate surgery and the remaining half initially engaging in a tailored physical therapy program. Both groups experienced benefits within 10 weeks, with ongoing reduction in lower back pain and improvement in physical function over four months. Remarkably, after two years, no significant disparity in pain or physical function was observed between the surgery and physical therapy cohorts.

Complications were more prevalent in the surgery group, where 25% experienced issues such as repeat surgery or surgery-related infections. In contrast, the physical therapy group exhibited fewer complications, with only 10% reporting worsening symptoms as a complication. These findings suggest that physical therapy stands out as a potentially safer and equally effective option for managing lumbar spinal stenosis when compared to surgery.

Weighing lower back pain treatment options

For individuals grappling with lumbar spinal stenosis and contemplating treatment options for lower back pain, particularly the decision to undergo surgery, the findings from this study provide valuable insights. Initially, conservative measures, such as pain relievers, anti-inflammatory drugs, and corticosteroid spinal injections, are commonly employed. If these approaches fail to yield improvements, surgery becomes a logical consideration, aligning with the conclusions of earlier research.

The study published in Annals suggests a nuanced approach, proposing that individuals with lumbar spinal stenosis should initially explore a well-structured physical therapy program. Dr. Jeffrey N. Katz, a professor of medicine at Harvard Medical School, advocates for this approach in his editorial on the study results. If physical therapy falls short in alleviating lower back pain, the decision to proceed with surgery should be individualized, taking into account the person’s preferences.

Immediate surgery may be imperative in cases where excessive nerve pressure leads to weakness in the muscles around the pelvis or upper legs, loss of control over bladder or bowel function, or unmanageable pain. Laminectomy, the most common surgical procedure, involves removing the bony plate (lamina) on the back of the affected vertebra, creating more space for the spinal nerves. This minimally invasive operation can be guided by video from a miniature camera through a small incision.

In instances of significant narrowing where a standard laminectomy is insufficient, a laminectomy with spinal fusion might be necessary. This advanced procedure involves not only removing bony plates but also extracting discs and other tissues while stabilizing the spine with cement or hardware. However, research indicates that laminectomy alone is equally effective as spinal fusion and is generally preferred as the primary option for relieving lower back pain when feasible.