April 7, 2010
A study in the April 7 edition of the Journal of the American Medical Association (JAMA) highlights the rise of complex and risky spinal fusion surgeries among Medicare patients with simple spinal stenosis. The study shows that there is little evidence of benefits and a much higher risk of life-threatening medical complications. This confirms that it is vitally important to look at alternative methods to treat this condition, such as physical therapy, which may help patients avoid long-term use of medications and their side effects as well as the risks and costs associated with surgery.
For pain of a mechanical origin such as in the back or neck, physical therapy to mobilize the spine, combined with exercises to alleviate low back pain, has been shown to be an effective treatment option. Patients with lumbar spinal stenosis can benefit particularly when manual physical therapy, specific exercises, and a progressive walking program are used in combination.
As this JAMA study indicated, most patients with back pain can achieve functional improvement and pain relief without complex surgery with its high cost and greater risk of complications. A study in the journal Spine (July 15, 2008) reported that patients who receive physical therapy for low back pain are less likely to seek additional medical care up to one year following treatment, making physical therapy a potentially more cost-effective approach.
Considering the fact that there is scant evidence for performing complex spinal surgery in patients with a simple lumbar spinal stenosis, placing Medicare patients at unnecessary risk and adding an unnecessary financial burden to the Medicare system is simply unacceptable. It is important for these patients to know that physical therapist intervention can be an effective, more affordable, conservative solution for treatment of spinal stenosis and other forms of back pain. Physical therapists are valuable partners on a patient's health care team, working with physicians and others to find the best solutions for patients.
APTA President R. Scott Ward, PT, PhD