SPINAL STENOSIS – SURGERY OR MANUAL DECOMPRESSION?

If you need a recipe 

Against stenosis ruining your life, 

Think of manual therapy 

Rather than the surgeon’s knife!   

– Doctor, I have spinal stenosis. They told me at the Bone and Joint Disease Institute that surgery is my only option. Can you help me?  

These are the first words my anxious patient is eager to utter, even before I ask him any questions. After I calm him down, it turns out that his back pain began five or six years ago. It was difficult to get up from bed and make his first steps in the morning. For the past couple of years, he has had problems walking. After half an hour or so his legs become heavy like lead, and he needs to sit down to avoid agonizing pain. An MRI test showed that two bulging disks in his lumbar spine are compressing his spinal channel.  

Well, his complaints are in line with the MRI test. The sufferer is eager to hear his verdict. Is it the surgeon’s scalpel or a lifetime of agony? Well, fortunately, other options are available. Here is some background information.   

What on Earth is spinal stenosis? 

Spinal stenosis was first described in 1803 by Antoine Portal. In 1954, Henk Verbiest reported successful treatment of four cases of spinal stenosis in the lumbar segment by laminectomy (the surgical removal of the back part of the vertebra that compresses the nerves).  

“Stenosis” is the Greek word for “narrowing”. When an intervertebral disk is flattened by overloading or chronic wear, it turns from a “bun” into a “bagel” and bulges towards the spinal channel and the intervertebral openings (foramena). The spinal channel is a long tunnel that contains the spinal cord; the intervertebral openings are like windows (or, rather, portholes) for the passage of the nerve roots to the periphery.  

Stenosis means that an intervertebral disk, flattened by overloading or chronic wear, turns form a “bun” into a “bagel” and bulges towards the spinal channel and the intervertebral openings. 

The narrowing of this channel causes compression and pinching of sensitive nerve structures and, as a consequence, pain and weakness in the muscles associated with the affected nerves.  

Stenosis is treated by decompression of the pinched tissue. Surgical treatment involves trimming of a piece of the flattened disk and the expansion of the bone channel. Conservative treatment reduces spasms and inflammation around nerve roots by means of manual therapy.  

Various types of decompression 

“How can conservative decompression replace surgery?” you may wonder. Well, compression arises from two principal factors: (1) the mechanical narrowing of the bone channels due to a disk injury and (2) the inflammatory swelling of the nerve roots in combination with a reflex spasm of the adjacent muscles that exacerbates stenosis and compression. The first part of this two-prong problem may be addressed only by surgery, but the second one responds favorably to proper rehabilitation therapy.  

Compression arises from the mechanical narrowing of bone channels and the inflammatory swelling of nerve roots. The second part of the problem may well be addressed by manual therapy. 

Treatment begins with reversing inflammation. Special massage drains the excessive lymph, while laser treatment, acupuncture, and manual impact on the affected area reduce inflammation and relax muscle spasms.  As the nerve root becomes less swollen and spasmed muscles relax their painful grip, the compression suffered by the nerve root drops by half or even more. At this point, the patient experiences substantial relief, although his flattened disk is still bulging and the spinal canal is still narrowed. But (between you and me) -- isn’t the final result more important than an X-ray image or a surgeon’s opinion? Once the patient starts moving, the treatment continues by means of gentle stretching of the spine (manual axial decompression, or MAX-D) and a special exercise regimen that strengthens the patient’s core muscles to further stabilize his spine and ensure a lasting recovery.  

The choice between surgery and non-invasive treatment is clear: try the conservative therapy first.  Good clinics boast a success rate of 80 to 90 percent for such therapy.  

Mind it, I am not a blind opponent of surgery, which is becoming increasingly non-invasive and successful. On the other hand, measure twice before you cut once – especially with a surgical knife!