It isn’t. We don’t really have a consensus on what findings define spinal stenosis over low back pain that isn’t spinal stenosis. The diagnosis is descriptive, stating that the hole the nerves in your spine go through has gotten narrower. Narrower than what is the question, because few of us have that yearly spinal hole check to get a baseline of normal. I had a patient brag to me recently that his spinal hole is bigger than normal. But again, we don’t know what normal is.
The biggest problem is that a diagnosis like spinal stenosis makes you think we have a treatment. What we have are the same treatments that we have for chronic low back pain, and none of them really work that well. When you have to define success as a 15% decrease in pain, that’s not a big wow in terms of patient satisfaction.
So what should Jim Calhoun do? Well, I suspect he’s not the kind of guy who gets a lot of massages. He could do worse. Seriously, have a look at the massage info and then browse through his alternatives below. He could also go for some heated acupuncture before he has his back surgery.
Zhongguo Zhen Jiu. 2012 Jan;32(1):17-20.
[Article in Chinese]
Lu WF, Kou ST, Ni JL.
Tianshan Road Community Health Service Center in Changning District, Shanghai 200051, China.
To observe the difference effects between warming-promotion acupuncture and normal acupuncture on lumbar spinal stenosis (LSS).
Sixty cases of LSS were randomly divided into a normal acupuncture group (30 cases) and a warming-promotion acupuncture group (30 cases). The two groups both chose Dazhui (GV 14), Mingmen (GV 4), Jiaji (EX-B 2),etc. Normal method without special manipulation was used in normal acupuncture group, while the warming-promotion manipulation was used in warming-promotion acupuncture group, all once daily, 10 treatments made one session. Compare the symptoms and spinal cord function of LSS, quality of life (QOL)and clinical effect in the two groups.
The comprehensive score of symptoms of LSS in warming-promotion group 3 months after treatment was 6.30 +/- 1.92, while that in normal acupuncture group was 4.67 +/- 13.70. The score of spinal cord function in warming-promotion group after treatment was 7.03 +/- 1.03, while that in normal acupuncture group was 6.33 +/- 1.12. The score of QOL in warming-promotion group after treatment was 53.67 +/- 8.91, while that in normal acupuncture group was 64.50 +/- 16.69. All the differences between these scores in two groups were statistically significant (all P < 0.05). The total effective rate was 90.0% (27/30)in warming-promotion group, and 80.0% (24/30) in normal acupuncture group. The effect of warming-promotion group was better than that in normal acupuncture group (P < 0.05).
In the field of treating LSS, the effect of warming-promotion acupuncture is better than normal acupuncture.
J Med Assoc Thai. 2011 Dec;94(12):1487-94.
Functional outcome after decompression and instrumented arthrodesis in degenerative lumbar spinal stenosis: factors influencing unsuccessful outcome change.
Keorochana G, Laohacharoensombat W, Wajanavisit W, Chanplakorn P, Woratanarat P, Chatchaipun P.
To determine functional outcome after decompressive laminectomy and instrumented arthrodesis in patients with degenerative lumbar spinal stenosis and identify predictors of failed clinical outcome in these patients.
MATERIAL AND METHOD:
A retrospective cohort data were collected from January 1999 to February 2004. Degenerative lumbar spinal stenosis patients who had decompressive laminectomy and instrumented fusion with pedicular screw system and completed at least 2 years follow-up were enrolled in the present study. Outcomes included Oswestry Disability Index (ODI), Roland Morris score and patient satisfaction. Factors evaluated as outcome variables were age, gender onset, patient income, associated diseases, smoking, diagnosis of spondylolisthesis or scoliosis, number of levels of instrumentation and presence of S1 fusion. Univariate analysis for factors influencing failed clinical outcome used Chi-square and Fisher exact test and multivariate analysis used the logistic regression.
One-hundred and fifty-eight patients were included in the present study. Mean follow-up was 2.64 years (range, 2-5 years). The mean age of the patients at the time of surgery was 60.3 years (range, 34-87 years) and 129 cases (81.7%) were female. According to the US FDA, the criteria of significant successful clinical outcome change is reduction of ODI at least 15%, the proportion of patients reporting significant successful clinical outcome change was 63.9%. Multivariate analysis identified age > 65 years, onset > 24 months and number of levels of instrumentation > 4 as the factors of failed clinical outcome change (p < 0.05).
Decompression and instrumented arthrodesis in degenerative lumbar spinal stenosis gained satisfactory functional outcome. Older age, prolonged onset and long level of instrumentation were the factors of failed clinical outcome change.
BMC Musculoskelet Disord. 2011 Jul 28;12:175.
Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review.
Steurer J, Roner S, Gnannt R, Hodler J; LumbSten Research Collaboration.
Horten Centre for patient oriented research and knowledge transfer, University Zurich, Raemistrasse 100, CH 8091 Zurich, Switzerland. firstname.lastname@example.org
Beside symptoms and clinical signs radiological findings are crucial in the diagnosis of lumbar spinal stenosis (LSS). We investigate which quantitative radiological signs are described in the literature and which radilogical criteria are used to establish inclusion criteria in clincical studies evaluating different treatments in patients with lumbar spinal stenosis.
A literature search was performed in Medline, Embase and the Cochrane library to identify papers reporting on radiological criteria to describe LSS and systematic reviews investigating the effects of different treatment modalities.
25 studies reporting on radiological signs of LSS and four systematic reviews related to the evaluation of different treatments were found. Ten different parameters were identified to quantify lumbar spinal stenosis. Most often reported measures for central stenosis were antero-posterior diameter (< 10 mm) and cross-sectional area (< 70 mm(2)) of spinal canal. For lateral stenosis height and depth of the lateral recess, and for foraminal stenosis the foraminal diameter were typically used. Only four of 63 primary studies included in the systematic reviews reported on quantitative measures for defining inclusion criteria of patients in prognostic studies.
There is a need for consensus on well-defined, unambiguous radiological criteria to define lumbar spinal stenosis in order to improve diagnostic accuracy and to formulate reliable inclusion criteria for clinical studies.
Spine (Phila Pa 1976). 2011 Sep 15;36(20):E1335-51.
Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials.
Kovacs FM, Urrútia G, Alarcón JD.
Departamento Científico, Fundación Kovacs, Palma de Mallorca, Spain. email@example.com
To compare the effectiveness of surgery versus conservative treatment on pain, disability, and loss of quality of life caused by symptomatic lumbar spinal stenosis (LSS).
SUMMARY OF BACKGROUND DATA:
LSS is the most common reason for spine surgery in persons older than 65 years in the United States.
Randomized controlled trials (RCTs) comparing any form of conservative and surgical treatment were searched in CENTRAL, MEDLINE, EMBASE, and TripDatabase databases until July 2009, with no language restrictions. Additional data were requested from the authors of the original studies. The methodological quality of each study was assessed independently by two reviewers, following the criteria recommended by the Cochrane Back Review Group. Only data from randomized cohorts were extracted.
A total of 739 citations were reviewed. Eleven publications corresponding to five RCTs were included. All five scored as high quality despite concerns deriving from heterogeneity of treatment, lack of blinding, and potential differences in the size of the placebo effect across groups. They included a total of 918 patients in whom conservative treatments had failed for 3 to 6 months, and included orthosis, rehabilitation, physical therapy, exercise, heat and cold, transcutaneous electrical nerve stimulation, ultrasounds, analgesics, nonsteroidal anti-inflammatory drugs, and epidural steroids. Surgical treatments included the implantation of a specific type of interspinous device and decompressive surgery (with and without fusion, instrumented or not). In all the studies, surgery showed better results for pain, disability, and quality of life, although not for walking ability. Results of surgery were similar among patients with and without spondylolisthesis, and slightly better among those with neurogenic claudication than among those without it. The advantage of surgery was noticeable at 3 to 6 months and remained for up to 2 to 4 years, although at the end of that period differences tended to be smaller.
In patients with symptomatic LSS, the implantation of a specific type of device or decompressive surgery, with or without fusion, is more effective than continued conservative treatment when the latter has failed for 3 to 6 months.
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