I hear the Japanese are having good success treating their older adults with lumbar spinal stenosis. What are they doing that we aren't?

A recent study from Kobe University in Japan reviewed the results of conservative care for lumbar spinal stenosis (LSS). They reported a good to excellent outcome. A closer look at this study is warranted.

They started out with 263 patients 70 years or older who had painful LSS. Each one was treated in the hospital for at least two weeks with traction, body cast, and/or injections. Less than half got better. The rest ended up having surgery.

Of the patients who did get relief from their symptoms only one-third were still "improved" at the final follow-up. The rest were unchanged or worse. Some went on to have surgery.

The study was able to show that the patients most likely to have a good result without surgery have radicular symptoms from pressure on the spinal nerve roots. These include pain and numbness down the leg.

Patients who ended up having surgery had numbness in the groin area with changes in bladder function. For these patients a myelogram showed a complete block of nerve messages. This points out the need to look at the location and effects of LSS when choosing conservative over surgical care. The type of care offered in Japan isn't anything new or different from what's been tried in the U.S.