ó When it comes to treating lumbar spinal stenosis in the
lower back area, physical therapy can be as effective as
surgery, a University of Pittsburgh study has found.
might be the best option to try first. That was Dale Urbanís
thinking at age 78.
Pittsburgh-area resident said pain progressively worsens
whenever he walks 50 to 100 yards or does dishes.
the bottom end of the spinal area is where I feel increasing
pain that goes from zero to 100," he said. "I feel
the intensity rising. I sit down and the pain goes away."
physical therapy includes riding a stationary bicycle,
physical manipulation of his lower spine and assigned
exercises he does at home.
first experience is, you get relief from the treatment, but itís
temporary relief right now," Urban said, after four of 12
sessions. "Iím hoping for long-term relief after I
undergo all the treatments and modulations."
University of Pittsburgh study, published online in the Annals
of Internal Medicine, found nearly equal success between
physical therapy and decompression surgery for lumbar spinal
stenosis, a degenerative condition that commonly occurs as
of the spinal canal in the lumbar region from age, arthritis
or many other factors can compress the spinal cord or the
nerve roots exiting the spine to form large nerves. Resulting
compression of these nerves can cause pain, numbness and
weakness in the lower back, buttocks, thighs and legs.
Decompression surgery is now the fastest-growing intervention
in the older population.
proportions of successes were similar" between those who
had surgery versus physical therapy, "there also were
similar proportions of patients (in each group) who did not
achieve a clinically meaningful level of improvement,"
the study said.
study would be necessary to determine why people respond
differently to treatments.
participants in the study were diagnosed via magnetic
resonance imaging (MRI) and existence of pain from walking, as
happened to Urban. Such pain typically disappears once the
person sits down.
first thing people should strongly consider is exhausting all
non-surgical options. Surgery should be the last resort,"
said Anthony Delitto, study leader and chairman of Pittís
Department of Physical Therapy. "The study shows that
people donít exhaust nonsurgical options. Physical therapy
is one option and based on the study, itís a good option,
and people should consent to that before surgery. Even if you
decide on surgery, it should be a shared decision with the
surgeon with full knowledge of the expectations of
169 participants, 87 were randomly assigned to have surgery
and 82 to have physical therapy. In the first group, 74
patients underwent surgery, with 45 showing success after two
years (a 61 percent success rate). Another 44 patients were
assigned to receive physical therapy, but opted instead to
have surgery, with 24 having success (or 55 percent). Of the
other 29 patients who completed physical therapy, 15 had
long-term relief (52 percent). There were no gender
differences in the results, the study says.
some quit therapy in favor of surgery, Delitto said, were the
health-insurance copays, which ranged from $20 to $50 for each
therapy session. Insurance tended to cover all costs of
surgery, including copays.
Delitto, a physical therapist with a Ph.D., said the total
cost of 12 rounds of physical therapy was $1,440, including
almost $300 in out-of-pocket expenses and copays. The cost of
decompression surgery is $24,000. More people likely would opt
for more cost-effective therapy if Medicare and other health
insurance companies eliminated copays.
need to remove barriers to more cost-effective
solutions," Delitto said.
the very least, someone should try physical therapy before
consenting to surgery. With a study like this, payers might
reduce the copay or eliminate it," at least for a minimum
number of therapy sessions.
A. Deyo, professor of family medicine at Oregon Health and
Science University, said the Pitt study is interesting and
important, especially given its well-organized, structured
approach to providing physical therapy.
the study shows therapy to be "a reasonable choice for
patients" with spinal stenosis.
fair to say that the surgical approach is often helpful for
symptom relief, but you must realize itís not a permanent
cure for some people," Dr. Deyo said. "Some have to
undergo surgery again" with increasing risks.