Evidence-Based Evaluation and Current Practice of Non-Operative Treatment Strategies for Lumbar Stenosis

Abstract

OBJECTIVE: A number of non-operative treatment protocols have been proposed in the literature for lumbar stenosis. However, the available primary research describes inadequately the employed protocol. This causes diffi culties in distinguishing which interventions are more effective in reducing symptoms. METHODS: We reviewed existing studies in order to promote the construction of an evidence-based strategy for non-operative treatment rehabilitation of lumbar stenosis patients. Randomized controlled trials describing insuffi ciently the non-operative treatment rehabilitation protocols were excluded since the results may not direct this review towards a favorable treatment plan. RESULTS: A protocol has been outlined to inform the clinician and to elucidate the effectiveness of non-operative treatment through randomized controlled trials. The results of this study indicate that a comprehensive exercise and manual therapy protocol is more effective in reducing symptoms than a less intensive exercise program. CONCLUSIONS: A comprehensive non-operative treatment comprising of fl exion exercises, manual therapy and treadmill exercises appears to be more benefi cial in reducing symptoms than a less vigorous program comprising of fl exion exercises, treadmill training and home exercise.

Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?

“…This indicates CSE can play an active role in relieving pain, and improving daily activities for patients with degenerative LSS. The results confirmed the conclusion of many scholars 3,8,9. In terms of the mechanism of CSE in treating LSS, we attribute it to its effect on lumbar alignment.…”

“… 2 With the aging society, more and more old adults may suffer from the disease, which affects the life quality of patients and exerts a heavy burden on social security systems. Conservative treatment is the primary option for LSS, 3 there is no significant difference in long-terms efficacy between conservative and surgical treatment. 4 Moreover, some authors suggest that neither the clinical manifestations nor the efficacy of conservative treatment is significantly correlated with the severity of spinal stenosis.…”

Understanding the mechanisms of a combined physical and psychological intervention for people with neurogenic claudication: protocol for a causal mediation analysis of the BOOST trial

“…16 Because of the risks, costs and unclear benefits associated with surgical treatment, [16][17][18] it is widely accepted that nonsurgical treatment should be first-line care. 19 20 Advice, exercise and self-management strategies are often used in clinical practice [21][22][23] but there is limited robust evidence to demonstrate their efficacy and effectiveness. 17 The Better Outcomes for Older people with Spinal Trouble (BOOST) trial is a large multicentre randomised controlled trial (RCT) testing the effectiveness of a 12-week Strengths and limitations of this study ► Causal mediation analysis of clinical trials can explain how an effective intervention works, or why an ineffective intervention does not work.…”

“… 16 Because of the risks, costs and unclear benefits associated with surgical treatment, 16–18 it is widely accepted that non-surgical treatment should be first-line care. 19 20 Advice, exercise and self-management strategies are often used in clinical practice 21–23 but there is limited robust evidence to demonstrate their efficacy and effectiveness. 17 …”

Effect of Integrated Exercise Protocol in Lumbar Spinal Stenosis as Compare with Conventional Physiotherapy- A Randomized Control Trial

“…There are lack of evidence in support of commonly utilized conservative interventions continues to result in lack of clarity regarding what intervention should be utilized to manage patients with LSS [17]. So, there is a need to establish the optimal rehabilitation treatment strategy for lumbar stenosis patients, as the comprehensive non-operative treatment provides better results to manage the LSS which improve the health status of the patient with least side effects and problems [18].…”