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christian@orthogate.com






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Our family is trying to help both our parents with health concerns. They have both been diagnosed with stenosis in the low back. What's the best treatment for this problem? At their ages (80 and 82), they don't want surgery. What are the other options?

Clinical guidelines for the diagnosis and treatment of lumbar spinal stenosis (LSS) have been published by the North American Spine Society (NASS). A large group of health care specialists worked together to make recommendations based on high level of evidence in the literature.

They reviewed all studies up to April 2006 looking for high quality work with dependable results. They found that for up to half of the patients with mild to moderate stenosis, the prognosis is favorable. Pain can be controlled allowing for greater movement and function. Serious neurologic problems are rare in this group.

There wasn't enough evidence to come to a conclusion about the long-term effects of severe LSS. Treatment options include a wide range of modalities from medications to physical therapy to surgery.

Overall, there isn't enough evidence from studies to support one treatment approach over another. There are very few studies that show the use of medications provides positive long-term results.

Using measures of pain and function, it appears that the use of a lumbosacral corset can increase walking distance and decrease pain for these patients. However, once the support is removed, the benefit goes away. Physical therapy alone without other treatment has not been studied but a few reports suggest it may be helpful for certain subgroups of patients.

Much more research is needed to sort out who should have what treatment. Steroid injections, manipulation, electrical stimulation, and traction are just a few approaches used alone or together but without enough studies to show if they really work or not. Some things may provide short-term relief but no apparent long-term effects.

For now, it may be best to use a team approach. Your parents' physicians can help you develop a reasonable plan based on your parents' wishes. Sometimes it requires a step-by-step program of trial and error to find what will give them the results they are looking for. Be patient with the process as it may take some time.


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