"Surgery is a riskier procedure, with about a 15 percent
complication rate, and half of those are
life-threatening," said Dr. Anthony Delitto, chair of
physical therapy at the School of Health and
Rehabilitation Sciences at the University of Pittsburgh.
"It isn't a life-risking procedure to do physical
therapy."Lumbar spinal stenosis, a compression of open spaces in the lower spinal column, can lead to pinched nerves, tingling, weakness and numbness in the back and the lower extremities. The condition becomes more common with age, and an estimated 2.4 million Americans may have it by 2021, according to the American Academy of Orthopedic Surgeons.
Delitto and colleagues set out to see if they could show that physical therapy, long known to be safer than surgery, could work as well as at easing symptoms.
Between 2000 and 2005, they asked 481 patients who consented to surgery if they would be willing to join a study where they would be randomly chosen to proceed with the operation or receive physical therapy. Most declined, to avoid being assigned to the non surgical group, but 169 patients agreed to participate in the experiment.
Ultimately, 87 patients had surgery and 82 were assigned physical therapy.
At the start of the study, patients were at least 50 years old. They had to be able to walk at least a quarter mile without difficulty and have no underlying medical conditions such as dementia, severe vascular disease, cancer, or a prior heart attack.
Most of them were sedentary or only mildly active, and they were typically obese. Patients in the surgery group were slightly younger, about 67 on average, compared with an average age of about 70 for patients receiving physical therapy.
The physical therapy regimen consisted of twice-weekly rehabilitation sessions for six weeks. Participants were allowed to opt out of this regimen in favor of surgery at any point during the study, and over an average two years of follow-up 47 of them, or 57 percent, did just that.
No matter what group they started in, participants achieved similar reduction of pain and other symptoms at two years.
"The study demonstrates that both surgery and physical therapy are reasonable choices; the person who goes down either path ends up in the same place a year or two later," said Dr. Jeffrey Katz, director of the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital in Boston.
