What are your spinal stenosis options? Should you have surgery? This has been a rough 5-10 years for surgeons who operate on the joints and the spine. Study after study comparing common surgeries to either placebo surgery (i.e. a fake operation) or physical therapy continues to show that many procedures don’t work. The most recent victim this week was invasive spinal stenosis surgery which over two years wasn’t any better than safe and simple physical therapy. Ouch!!!
Spinal stenosis is a condition where the spinal cord or nerves in the spinal canal (which lives in the middle of the vertebra), get compressed by bone spurs and enlarged ligaments because of wear and tear arthritis. This can cause severe pain in the back and legs with standing, which generally improves when sitting or bending forward. This is because standing closes off the space for the nerves and any kind of flexion opens it up. Most patients with this condition and who continue to have pain or weakness in the legs are sent for invasive spine surgery to widen the space by cutting out the enlarged bone and ligaments. However, the surgery can have significant side effects with 15-20% of patients having complications and about half of those being serious. Believe it or not, we’ve had very little hard scientific evidence that spinal stenosis surgery is effective. These past few months, the results of the SPORT trial that compared surgery outcomes to the results of patients who decided to forego surgery were published. The results showed that while spinal stenosis surgery patients seemed to fare better for the first few years, by the fourth year the ouctomes were the same as patients who didn’t have surgery.
The new study went one step further by randomizing and assigning spinal stenosis patients to physical therapy or surgery. The patients were all fairly miserable when they began the study, with pain at a 7/10. Mobility assessments were performed at the 10-week point, at six months and at one year. Two years after either surgery or physical therapy, patients filled out surveys to assess pain, function, and symptoms. The result? In terms of pain relief and improved function, there was no long-term difference between the invasive surgery and physical therapy! Meaning that the patients that took great risk by undergoing the surgery had no more benefit than the patients who got randomized to the 100% safe physical therapy.
The upshot? Spinal stenosis can be both frightening and awful. Patients are often told by surgeons that they may become paralyzed if they don’t undergo the surgery, so many just opt for a big operation with many serious side effects. However, these two new studies are showing that the surgery results aren’t all their cracked up to be and that avoiding spinal stenosis surgery may be the best choice. However, if you have spinal stenosis and physical therapy and epidurals haven’t helped, what can you do? We’ve had significant success using our DDD procedure to attack the cause of the spinal stenosis through a series of regenerative injections rather than surgery.