Focused Spinal Stenosis Rehabilitation Program for Lumbar Spinal Stenosis

Hospital for Special Surgery, New York

Overview

Lumbar spinal stenosis with neurogenic claudication is a common condition in the elderly population and is characterized by bilateral buttock, thigh, or calf discomfort and/or pain, as well as by weakness precipitated by walking and prolonged standing. Self-management options include physical therapy, which includes exercise as a core component for improving the flexibility and mobility of the spine and hips. A Williams flexion protocol has historically been used to treat low-back pain following degenerative changes to the posterior elements of the lumbar spine. However, few studies have been done to validate the efficacy of this protocol. A more focused treatment protocol may be more efficacious. Patients in this study will be randomized to receive either the generic physical therapy protocol (15 sessions) or the focused rehabilitation program (5 sessions). The sessions will take place over the course of 6 months. Outcomes will be assessed using validated questionnaires and physical function tests.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Conditions

Spinal Stenosis Lumbar

Interventions

Williams flexion protocolPROCEDURE

The Williams flexion protocol group will participate in 15 treatment sessions.

Focused spinal stenosis rehabilitationPROCEDURE

The focused spinal stenosis rehabilitation group will participate in 5 treatment sessions.

Eligibility

Sex: ALLMin age: 40 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Lumbar spinal stenosis with neurogenic claudication * Symptoms present for at least 3 months * Moderate to severe acquired or congenital LSS based on radiological evaluation * Lumbar MRI obtained within the past 12 months prior to initial physical therapy visit * 40 years of age or older * Body mass index less than or equal to 35 * Can tolerate a 6-min treadmill test * Willing to comply with home exercises as prescribed Exclusion Criteria: * Acute disc herniation * Grade 3 or greater spondylolisthesis * Rheumatoid or autoimmune conditions (e.g., ankylosing spondylitis) * Active spinal compression fractures * Knee surgery in the previous 6 months (e.g., total knee arthroplasty) * Previous spinal fusion * Absence of pedal pulses * Inflammation/infectious process * Myelopathy * Psychiatric disorder preventing informed consent or participation in assigned physical therapy sessions * Patients with pending litigation or workers compensation

Locations (1)

Hospital for Special Surgery

New York, New York, United States

Outcomes

Primary Outcomes

Change in functional ability

Change in functional ability will be assessed using the Oswestry Disability Index. The minimum clinically important difference of the ODI has been documented in the literature as a 13-point change.