Dealing with Lumbar Stenosis can be difficult, confusing, and cause a lot of frustration.
Life seems to speed up, and you seem to be slowing down, making it harder to keep pace with the things you want to do, and the activities that add value to your life.
The good news is, there is much you can do, on your own, to help you manage Lumbar Stenosis successfully, and there are also many options for care, each having something to offer to the right person, in the right situation.
However, the bad news is that far too many people end up making poor treatment choices that often lead to bigger problems. This is largely due to making these choices out of fear or having unrealistic expectations from the treatment they pursue.
Each of these “mistakes” occur because of getting bad information.
Knowing 5 key facts about Lumbar Stenosis will give you a solid foundation for making informed treatment choices and improve your odds of having the future you desire.
This brief post will provide an overview of these 5 important facts.
Fact 1: There are 3 main criteria that MUST be met, to reliably be diagnosed with Lumbar Stenosis.
Far too many people are given this diagnosis in error, without meeting these criteria, and it can lead to inappropriate treatment.
Here are the 3 criteria:
1. Your MRI must show a reduction in one, or more, of three different “spaces” that they nerves need as they travel through your spine.
2. The second is that you should have leg symptoms, at least as bad, (and usually worse) than what you are experiencing in your low back. Being a bit redundant, it is important to know, thar regardless of what your MRI shows, if you are ONLY having low back pain then you DO NOT have symptomatic Lumbar Stenosis.
3. The last of the 3 major criteria is that your symptoms should be clearly related to position or activity. This usually means that they are much worse when standing or walking and noticeably better when sitting or lying down.
Fact 2: Your MRI can be very misleading in the following 3 ways:
1. Your MRI may show Lumbar Stenosis, yet you may not be symptomatic from it. Remember, you need to meet the 3 criteria discussed above. Research studies, performing MRI’s on asymptomatic people have show it to be very common for these people to show stenosis on their scans. If fact, these same studies have suggested that ONLY 17% of people with severe stenosis on their MRI’s have symptoms.
2. You may have symptomatic Lumbar Stenosis, yet your MRI DOES NOT clearly show it. The main reason for this is that most MRI studies are performed in a supine position (laying on your back) and this often underestimates the significant spinal changes that occur during weight bearing. In these situations, dynamic imaging is often required (performing an MRI in various postures, such as sitting, standing, and bending backward) to arrive at a more precise diagnosis.
3. The last way that your MRI can fool you is to make you think that you MUST have surgery because of the amount of spinal narrowing seen on the scan. Numerous scientific papers have looked at this. They have consistently found that your MRI findings can NOT be used to determine if YOU NEED surgery, or how well you will do with surgery should you choose to go that route. Remember, most people with SEVERE stenosis are ASYMPTOMATIC. (discussed above)
Fact 3: There is no need be afraid and have your worries cause you to rush into treatment. The 4 main reasons for this are:
1. Lumbar Stenosis rarely worsens, and if it does, it is a slow and gradual process
2. Lumbar Stenosis may even get better on its own, without treatment. It is not uncommon to have times where you are more symptomatic, and other times where your symptoms are minimal.
3. There are many things you can do on your own to have a positive impact on this condition. Several scientific papers have shown that activities such as consistent walking, stationary cycling, water aerobics, and a few basic stretching and stabilization exercises can get you to the point where you will NOT need treatment.
4. And, maybe the most important, your treatment results (in particular surgery) have absolutely nothing to do with how long you wait to have treatment.
Fact 4: There is no such thing as the BEST type of treatment.
By this, I mean that science has never determined one form of care to be superior to any other form of care.
This is illustrated in the conclusions by the Cochrane Group (a group who does impartial research on numerous types of treatment).
Their most recent paper stated, “We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis.”
And, regarding conservative care, they further noted, “Moderate and high quality evidence for non-operative treatment is lacking and thus prohibits recommendations for guiding clinical practice.”
The reason that this is important is that it is not uncommon to meet with various clinical professionals, each having their own opinion about what they feel is the “best” type of care, or what is “right” for you. The fact that they rarely agree can lead to a great deal of confusion and decisional uncertainty.
It is also important to know, regardless of what care you receive, that it is impossible for any clinical professional to predict with certainty how well you with their treatment.
“So, in summary, science has NOT clearly determined a “BEST” approach to care. All forms of treatment have something to offer and have had their successes and failures.
Knowing this, it is crucial that you work with someone who will help you understand your options, what they do, and well they perform so that YOU can make choices that are a good fit for YOUR life.
Fact 5: Treatment success is NOT what you think it is.
Too many patients go into treatment (especially surgery) and are expecting a “fix”. Far too many surgeons use the word when discussing what their surgery will do.
Fix is a bad term, it’s misleading, and it is not what typically occurs, regardless of the type of treatment received.
Here is one example. A fairly recent research paper studied over 6000 patients and found that a pain level of 3 (on a 0-10 point scale) would be considered a surgical “success.” Only 42% of these patients reached that level and considered their surgery a success.
Another study followed over 1700 patients who had surgery for Lumbar Stenosis. Here is what they found for low back pain:
· 16% complete relief
· 36% significantly better
· 18% maybe a bit better
· 13% no change
· 9% worse
Here is what this same study found for the leg pain associated with Lumbar Stenosis:
· 24% complete relief
· 29% significantly better
· 18% maybe a bit better
· 12% no change
· 11% worse
I make these points not to disparage surgery for Lumbar Stenosis, or to portray one type of treatment as being better than another (discussed above).
But rather, these points are made to help you have realistic expectations from the treatment you choose. In fact, numerous studies have illustrated how common it is for patients to have unrealistic expectations from their treatment and that this is a big reason for them to be dissatisfied with their results.
Thank you for reading. Your comments are always welcome.
Dr. Ron Fudala (RDF-10)
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