With a recent negative American view, it is nice to have a more encouraging German perspective. Though 2/3 go to surgery, 1/3 can be managed with physiotherapy, cycling exercise, psychotherapy, and injections – epidural, paraspinal, facet and sacroiliac.
Z Rheumatol. 2015 Apr;74(3):215-25. doi: 10.1007/s00393-014-1500-2.
[Lumbar spinal stenosis : From diagnosis to correct therapy].
[Article in German]
Benditz A(1), Grifka J, Matussek J.
http://www.ncbi.nlm.nih.gov/pubmed/25854156
Their consensus of treatment:
Conservative measure include:
- muscle lordosis (curvature) and stabilization training
- Being active – cycling is suggested as sitting posture opens up canal. I wonder if swimming would be considered as well
- Balneotherapy (spa) – well this is a German article so…
- Psychotherapeutic
Injections – they recognize this is controversial but have 60 cases they injected with local and crystalline steroid. After 1 year followup:
- Pain started at 7.21/10 and ended up at 3.58/10
- Patients rated treatment success in (35%) or satisfactory (52%)
- No negative reactions
Surgery – they point out: “The goal of all surgical procedures is to decompress the spinal canal without compromising the stability of the motion segment. This can make an additional fusion necessary.”
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The wild card here , is a study finding IV Pamidronate reduced spinal stenosis symptoms:
Clin Rheumatol. 2009 Jun;28(6):715-7.
An open study of pamidronate in the treatment of refractory degenerative lumbar spinal stenosis.
Feld J, Rosner I, Avshovich N, Boulman N, Slobodin G, Rozenbaum M.
http://www.ncbi.nlm.nih.gov/pubmed/19219479
- 24 patients with neurogenic claudication
- pamidronate “60 mg in 500 cc normal saline, over 4 hours. After 3 months, those patients reporting some clinical response received additional three monthly infusions.” (15 had 6; 5 had 5; 6 and 3; 1 withdrew after 1)
- allowed some renal decline subjects: “Patients with stable serum creatinine levels between 1.5 and 2.0 mg/dl received a reduced dose of pamidronate, 30 mg, with those with more severe renal decline excluded.”
- VAS pain level went from average 7.6/10 to 4.6/10 by end treatment course (3-6 months) – mean improvement was 40%
- side effects – 5/24 had flu-like symptoms that started within hours of infusion and continued for several days
- 6/9 people reviewed at 8 months had no recurrence.
- tolerance may be poor among some cases as they can feel like they have quite a flu after the infusion…
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I have been using “sweet caudals” on chronic back pain cases – 10 mls of D5W (I put in 2000 ug b12 preservative free)[no local] – with a short needle – 1″ -27 in thin and 2″ – 25 in bigger. They don’t last long initially but repeated ones are supposed to last longer. Don’t know how useful yet…
Any other ideas?