Nonoperative management of lumbar spinal stenosis

To describe the successful treatment of a patient with lumbar spinal stenosis utilizing nonoperative procedures.

A 76-yr-old male with a chief complaint of low back pain and left lower extremity pain demonstrated the following per history and physical examination: 1. A right antalgic shift. 2. Restricted lumbar range of motion with provocation of left lower extremity pain during extension. 3. Generalized lumbar spondylosis as revealed on plain film X rays. 4. MRI confirmed lumbar stenosis. A diagnosis of lumbar spinal stenosis secondary to spondylosis was made.

Twelve treatments of flexion-distraction manipulation, deep tissue massage, ultrasound, therapeutic exercise, heel lift, and modification of activities of daily living. He was discharged from care asymptomatic in 3 wk. Objective improvement was also noted.

Conservative treatment designed to increase lumbar flexion, thus increasing lumbar spinal canal volume, has a positive influence on the diminution of neural ischemia and its resultant neural dysfunction. Additional research is needed to elucidate these concepts.