Jeff Langmaid explains how decompression surgery for lumbar stenosis can relieve nerve compression but may destabilize an already compromised spine, potentially leading to fusion surgery later. He recommends conservative, movement-based treatment unless red flags are present.
Now if a patient has a compromised segment, which by definition they do, if they have lumbar stenosis, something's going on to cause that compression. Well, when a surgeon goes in and they're doing a laminotomy, a laminectomy, a foraminotomy, whatever the case may be, they're literally taking out material to create space. Now the benefit of that is that, knock on wood, they're creating some space. The detriment is if this is a compromised segment and this patient's not gonna get younger, they're gonna continue to be under load and gravity. Well, guess what? That's the fast track to having another surgery and that's the fast track to moving towards a fusion. So helping your patients understand what's going on in their body, helping them understand that movement based care, unless there's a red flag, is the best choice. And then setting the expectation of duration of care, absolutely critically important when you're taking care of individuals with lumbar stenosis.
