005- Chiropractic Care and Spinal Stenosis

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Hello and welcome to the Evidence Based Chiropractor. I am your host Dr. Jeff Langmaid. Happy Holidays. If you've been listening I would encourage you please comment, like and or subscribe to the Evidence Based Chiropractor podcast. It helps us out a ton and thank you for listening. Today we're going to talk about a piece of research that was released in the year 2006. It is titled A Non Surgical Approach to the Management of Lumbar Spinal Stenosis A A Prospective Observational Cohort Study and it was produced by BMC Musculoskeletal Disorders in 2006. But before we dive in, let me say a few words about Rocktape. Rocktape is proud to be a sponsor of the Evidence Based Chiropractor. Rocktape offers the world's best kinesiology tape, pain relief, topicals, mobility tools and functional fitness accessories. New from Rocktape is Rocksauce Chill, a of piece powerfully cool pain relief topical in a convenient roll on with 6% menthol. It's stronger than the freeze competition. Rock Tape is more than a tape company, they are a movement company. Learn more and get access to your medical discount by visiting rocktape.com so today's episode is going to focus on something all of us see each and every day in practice. That is patients with lumbar spinal stenosis. So so lumbar spinal stenosis typically is multifactorial in nature, meaning that the compression can come from bone, disc or ligament. Sometimes that may be a disc bulge, disc herniation, other times it may be ligamentum flavum hypertrophy and certainly end plate changes. Osteophytes and bone spurs can often contribute to spinal stenosis. The research that we're going to touch on today, again it's titled A Nonsurgical Approach to the Management of Lumbar Spinal Stenosis. A Prospective Observational Cohort Study Lumbar stenosis, again, it's mechanical in nature. It is actually a true compressive pathology on the spinal cord or thecal sac in the lumbar spine. With the current lumbar spinal stenosis incident rate of 8 to 11% worldwide, it's a condition that of course again we all are seeing every day. In practice. This study shows chiropractic low velocity lumbar flexion distraction to be a promising non surgical treatment option for these patients. That, that's very exciting from a mechanical perspective that we're able to decrease the pain and improve the function of patients suffering from lumbar stenosis. The hallmark of lumbar spinal stenosis is neurogenic claudication. However, the secondary radiculopathy can often be mistaken for lumbar disc herniation or nerve root compression secondary to the aforementioned lumbar disc herniation. So, so from a clinical perspective, during your evaluation, during your examination, it's very important and of course relying on imaging, it's extremely important to be able to take the time and parse out the difference between what's the central component essentially the spinal stenosis and what may be a nerve root or a foraminal component causing radiculopathy with that. Anyhow, the flexion distraction technique provides a direct manual decompression to the afflicted spinal motion segments while attempting to mobilize the segment and decompress the nerve root. We're all very familiar with flexion distraction technique. Patient lies in a prone position and it's a very controlled low force technique that certainly can open up the canal. Just the act of flexion for patients with spinal stenosis can be very relieving. Typical case presentation for patients, of course, is that flexed position. It's typically bilateral numbness, paresthesia and, or pain and the big one, endurance issues. So patients consistently report that they can walk X amount of steps, yards or minutes and they have to sit down whether they have a chair or not, they're going to be going down one way or the other. So endurance issues with ambulation and walking is a primary, primary symptom or affliction for those suffering from lumbar spinal stenosis. Secondary to that, those patients are also going to report, hey, when I have a grocery cart in front of me, if I go to the grocery store, I, I can go two, three, four times as long and, or I can go on forever because again, they're getting into that somewhat flexed position, they're able to have some support underneath their arms and it really decreases the dysfunction associated with lumbar stenosis. So let's touch on a few key quotes from this research paper. The researchers found non surgical management should be the first line of approach in patients with lumbar spinal stenosis. That's good to hear. They also found lumbar spinal stenosis can lead to low back and leg pain, most typically via encroachment of the central canal, lateral recess or lateral canal. The source of the encroachment is typically vertebral body osteophytes, hypertrophy of ligamentum flavum or facet joint, or a combination of these. The development of these degenerative changes is often accompanied by restriction of the segmental mobility. So those are all key points. They're all things that we already touched on, but they're extremely important to keep in mind with treatment choice, with technique choice, and with the disability associated or dysfunction with patients that have spinal stenosis. Researchers also found a non surgical approach that attempts to target the unique pathophysiology of lumbar spinal stenosis may be best able to rapidly improve pain and function in these patients. Furthermore, clinically meaningful improvement in disability was seen in over 2/3 of the patients. So of course this paper is indicating a majority. Over two thirds of the patients in this study that were treated with flexion distraction technique, chiropractic technique with lumbar stenosis had clinically meaningful improvement in disability. So that's really the take home message here. 65.1% is the mean patient rated percentage of improvement. That's significant. And to me that's clinically significant. 5.1 points was the mean improvement in disability from the baseline to the end of treatment. Again, a five point swing or a 65% improvement in a non surgical capacity for a compressive pathology is very significant. And again, with all of these things that we're talking about each and every week, it's important that we can take this research out and that we can accurately discuss these papers with, with other practitioners in our area, in our hometown, whether that's md, do, pt, whatever the case may be, and the general public, because often the public even may be, let's say, swayed, or they may be unaware of what chiropractors can take care of. And I say take care of very loosely. Ultimately we're concerned with improving the function of the body. There's absolutely no question about that, regardless of what the patient comes into our office for. But patients that have lumbar stenosis, that have been told it's a mechanical issue, may lean away from chiropractic care, thinking that they have to have surgical treatment papers like this show and really give us the data to say, hey, the research is absolutely standing behind non surgical care for these types of issues. And chiropractic care, by the way, provides significant relief for a majority of patients with lumbar spinal stenosis. One thing to keep in mind with the rating of spinal stenosis is typically, whether it's a CT or an mri, the radiologist or yourself can look at an axial cut of either that lumbar cervical spine, in this case, we're talking about the lumbar spine. You're going to look at an A, you're going to look at an axial cut and then you're going to measure the A to P dimension of that canal. The number of millimeters in dimension, A to P dimension of that canal is going to help you in clarifying the grade or rating of that spinal stenosis on a report. This will typically be seen as from minor to major abutment, which means that there is touching of the thecal sac, but not compression. Then you will go mild, mild, moderate, moderate, moderate, severe, and severe. So those are really the classification types when you're reading those MRI reports or live reading those films with your patients. Of course, the higher up that scale you go, the more compression there is and the more symptomatic the patient may be. Irregardless of how far along they are on that spectrum, conservative care certainly is warranted. These are gonna be patients you're gonna keep a close eye on in practice, but many of them should get functional improvement with chiropractic care in your office. That's the great thing about studies like this is they give us the confidence and the knowledge to move forward. So with that I'll repeat, please rate, comment, subscribe and like this podcast on itunes. It helps us out tremendously. Have an awesome week in practice, have a great holiday, spend time with your family and loved ones and certainly get those batteries recharged for 2016. We have some really exciting things coming up in 2016. I'm hoping to be able to travel not only to England, but to the Netherlands and certainly throughout the United States with a variety of programs trying to give chiropractors really around the country and now around the world information and tools to help them practice with more confidence. So have a great week and we will see you next Monday on the Evidence Based Chiropractor podcast. Happy Holidays.

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