A recent (2014) study in SPINE examined the use of decompression without fusion for lumbar stenosis. They found that decompression without fusion can be just as effective as methods involving fusion, but has significant cost saving advantages and fewer complications. Generally, this decompression is accomplished by a laminectomy.
If fusion is warranted, they encourage the use of bone graft as opposed to instrumentation (hardware). It seems as though bone grafting is also more cost effective while providing similar outcomes. The study found that complication rates rose significantly for patients who underwent a laminectomy with fusion compared to those who just received a laminectomy.
It makes sense to me that limiting the use of instrumentation/hardware would yield decreased complications and perhaps even slight outcomes advantages. Instrumentation (while necessary with certain procedures) permanently alters the bio-mechanics of the spine and places vertebral segments adjacent to the surgical site at increase risk for degeneration.
Additionally, I believe it is important to stress that previous research has shown that chiropractic care (specifically flexion/distraction technique) has provided relief from lumbar stenosis. The complication rate for conservative chiropractic care is significantly lower than surgical intervention, and both have proven to be effective treatments. The degree, or amount of stenosis (and its impact on function) will play a large role in determining whether conservative care is an option for each individual patient. The bottom line is that physicians should be aware that surgical intervention is not the only treatment option available for patients with lumbar stenosis.
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