Severity of structural lumbar spinal stenosis does not impact responsiveness to exercise-based rehabilitation

Abstract

Abstract Importance Spine pain is a prevalent and costly condition affecting up to 85% of individuals throughout their lifetime, and spinal stenosis is one of the most debilitating sources of spine pain. Although conservative management is the first line of treatment for spinal stenosis, radiographically severe cases often are directly referred to surgical intervention due to the belief that conservative strategies delay necessary treatment. However, no studies support the premise that individuals with more radiographically severe stenosis respond poorly to conservative management. Objective The purpose of this study was to compare improvements in pain, disability, strength, medication usage, and patient function after an exercise-based physical therapist-led program. Design This study was a retrospective analysis of a single arm clinical trial. Setting This was in the setting of an outpatient exercise-based physical therapist-led program. Participants One thousand eight hundred six individuals with radiographically mild, moderate, or severe lumbar spine stenosis participated in this study. Intervention The intervention was an exercise-based physical therapist-led program. Outcomes and Measures Outcome measures included pain, low back pain related disability, patient specific function, analgesic medication use, and lumbar extensor strength. Results Participants demonstrated significant improvements in all variables of interest, and 11.5% of participants reported cessation of narcotic use with treatment. There were no significant differences in treatment response across radiographically mild, moderate, or severe stenosis groups for any outcome. Conclusions Exercise-based rehabilitation is as beneficial in the short term for individuals presenting for nonoperative care with radiographically severe stenosis compared to their milder counterparts. Relevance Exercise-based rehabilitation results in the same magnitude of improvement in individuals with chronic low back pain regardless of radiographic severity of spinal stenosis.