Is Surgery Your Best Option for Back Pain?

Physical therapy compared to surgery for spinal stenosis
Man rubbing his lower back. Back pain concept

Spinal stenosis, or narrowing of the spine, will affect an estimated 2.4 million Americans by 2021.

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It’s a common cause of back pain in people over 50 and is often treated with surgery.  However, a new study shows that physical therapy may be just as effective at relieving symptoms and returning mobile function.

Treatments for spinal stenosis

Spinal stenosis is a complicated diagnosis for most patients and their physicians.  It’s often difficult to pinpoint the cause of the stenosis, which also makes treating it complex.

“The narrowing of the spine causes pain in the legs and butt as the patient walks,” spine specialist Thomas Mroz, MD says. “While it doesn’t cause paralysis, it definitely has a negative impact on quality of life.”

Because of the condition’s complexity and the delicate nature of the spine, surgery as a form of treatment is usually a last resort.

“When you get to the point where symptoms are intolerable, you should consider surgery,” Dr. Mroz says.  “There are a lot of other options to try before you get to that point.”

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A course of treatment is usually determined by a discussion between the patient and physician.  Many patients are surprised by the amount of non-surgical options available, including: physical therapy, cortisone injections, consistent exercise or yoga, nerve blocks, or alternative medicine.  Physicians recommend all non-surgical options before ultimately offering surgery as a treatment.

Surgery vs. physical therapy

Researchers from the University of Pittsburgh Medical Center studied 169 patients with spinal stenosis from 2000 to 2007.  All of the participants were considered good candidates for spine surgery.  Half of the participants completed physical therapy two times each week for six weeks, and the other half had spine surgery.

The study results show that symptoms improved in both groups, suggesting that surgery and physical therapy can have similar effects on improving spinal stenosis.

Since surgery is considered only as a last resort and comes with risk, this is good news for patients.

“While the outcomes are certainly interesting, each case is different and some cases are better suited to one treatment over another,” Dr. Mroz says.

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While the study offered promising evidence that physical therapy be more closely looked at as a primary form of treatment, it has its limitations.

“Two sessions of physical therapy per week is probably not enough to make an impact,” Dr. Mroz says.  “Educating patients on what consistent exercise can offer – how it benefits the patient – is important.”

Dr. Mroz says that the outcome of physical therapy versus surgery is different for each patient depending on the patient’s engagement and the surgeon’s technique, among other variables.

Complete results for the study, Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis, can be found online in the Annals of Internal Medicine.

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