Letter to editor: Lumbar spine stenosis: current concept of management
Article information
Dear Editor,
I read with great interest the recent article by Kwon et al. [1], “Lumbar spinal stenosis: current concept of management,” published in Asian Spine Journal. The comprehensive overview provided by the authors on surgical and non-surgical approaches adds significant value to the existing literature. However, I would like to draw attention to several adjunctive and emerging approaches that may complement current management strategies.
Therapeutic exercise
Research supports the role of exercise-based rehabilitation and emphasizes its potential in conservative and postoperative management of lumbar spinal stenosis (LSS). Physiotherapy is predominantly relevant in conservative care, especially for individuals unsuitable for surgery. It is recommended that patients with symptomatic LSS engage in supervised exercises including lumbar flexion, aerobic activities, stretching, strengthening of trunk muscles, and cycling for fitness. Incorporating psychologically informed approaches may offer additional benefit. The impact of balance training also warrants further exploration [2]. Another investigation showed that patients with severe stenosis who completed exercise-based rehabilitation experienced comparable short-term improvements in pain, disability, goal attainment, strength, and narcotic cessation to those with milder forms of stenosis undergoing nonoperative care [3]. Early implementation of exercise protocols may help delay the need for surgical intervention. A systematic review noted that early rehabilitation following surgery mainly improves disability within a month, with notable pain reductions at one and 6 months, likely contributing to enhanced short-term functional outcomes [4].
Manual therapy
Manual manipulation therapy has been described as an effective treatment strategy for improving pain and dysfunction in patients with LSS [5]. Kim et al. [6] demonstrated that the application of flexion-distraction technique in individuals with lumbar stenosis led to marked improvements in both pain and functional scores. Existing reports highlight the benefits of combining therapeutic exercise with manual therapy, showing reductions in pain and disability, and improvements in function among LSS patients [7]. Specifically, low to moderate intensity aerobic exercise conducted for at least 6 weeks, when combined with flexibility and strengthening exercises with manual manipulation, seems more effective than any single modality alone [7].
Dry needling
Dry needling is gaining attention as an emerging adjunctive approach in the management of chronic low back pain associated with LSS. It is increasingly combined with standard physiotherapy interventions. A recent study reported that patients with LSS who received electrical dry needling combined with spinal manipulation, impairment-based exercises, manual therapy, and electro-thermal modalities showed greater improvements in low back, buttock, and leg pain as well as related disability at 3 months, compared to those receiving all other components without dry needling. However, the benefits were not evident at the 2- or 6-week follow-ups, highlighting the limitation of inconsistent short-term efficacy [8]. These findings suggest that while dry needling may enhance longer-term outcomes, further high-quality studies are essential to establish its timing and dosage.
Conclusion
Exercise, manual therapy, and dry needling may improve conservative and postoperative LSS management. While, exercise forms the foundation, combining it with manual therapy and exploring adjunctive modalities like dry needling may offer more comprehensive relief and functional gains for LSS patients.
Notes
Conflict of Interest
No potential conflict of interest relevant to this article was reported.
Author Contributions
All the work for the preparation of this letter was done by Hina Vaish.