Chiropractic and Spinal Stenosis

Lumbar spinal stenosis (LSS) is a serious health problem, especially among the elderly. “Spinal stenosis has been defined as any narrowing of the spinal canal or the various tunnels through which nerves and other structures communicate with that canal.” 1 The most common symptoms of LSS are:

• Pain and numbness in the low back.
• Pain and numbness in the legs and buttocks.
• Symptoms are usually worse after walking or extension of the lumbar spine.
• Symptoms improve with flexion of the lower back.

The authors of a new study2 discuss the problem of LSS:
“LSS is one of the most common reasons for spine surgery in older people, although little is known about the efficacy of surgical management of patients with LSS, particularly compared to non-surgical management. It is generally felt that most patients with LSS should be managed non-surgically before considering surgical intervention, but little is also known about what non-surgical approaches are most efficacious.”
The researchers set out to determine if chiropractic is beneficial for these patients. They studied 55 patients with LSS diagnosed by MRI or CT scans. Each patient was given questionnaires to determine disability and pain intensity before treatment and at a 16-month follow-up. In addition, the subjects were questioned regarding improvement every 3 to 4 weeks during treatment.
The patients were treated with the following techniques:

• Distraction Manipulation (DM) – a technique where the patient lies prone on a table that “allows for distraction of the spine through inferiorforward and flexion movement of the lower body.”
• Neural Mobilization (NM) – “a manual and exercise oriented method that is theorized to mobilize nerve roots that are suspected to be the source of nerve root pain.”

Patients were given individual treatment plans, but generally were seen 2-3 times per week for three weeks, then one or two times a week after that. The average number of treatments was 13.3.
The authors reported the following findings at the completion of treatment:

• The average patient-rated improvement was 65.1% from baseline to the end of treatment.
• The average patient improvement in disability was 5.1 points on the Roland Morris Back Pain and Disability (RM) questionnaire.
• There were also significant improvements in “worst pain.”

At the 16 month follow-up:

• The average patient-rated improvement was 75.6%.
• The average improvement in disability was 5.2 points on the RM.
• “Clinically meaningful improvement in disability was seen in 73.2% of patients.”
• The average improvement in “on average pain” was 3.0 points on the RM.
• The average improvement in “at worst pain” was 4.2 points on the RM.
• Only two patients needed surgery by the 16 month follow-up.

Other studies have looked at the natural course of LSS with conservative treatment, and it appears from this study that chiropractic may be more effective than other treatments. A 1996 study3 found that “non-surgical” treatment resulted in improvement of only 1.6 points on the RM after one year.
The authors conclude:
“The combination of DM and NM may be a safe and effective approach for patients with LSS. Because the sample size is relatively small and there is no control group, firm conclusions regarding this cannot be drawn. The outcome of this approach compares favorably with other non-surgical treatments, and treatment with DM and NM may be a viable non-surgical option before considering surgery for LSS.”

1. Nowakowski P, Delitto A, Erhard RE. Lumbar spinal stenosis. Physical Therapy 1996;76:187-190.
2. Murphy DR, Hurwitz EL, Gregory AA, Clary R. A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study. BMC Musculoskeletal Disorders 2006;7:16.
3. Atlas SJ, Deyo RA, Keller RB, et al. The Maine Lumbar Spine Study. Part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine 1996;21:1787-1795.