Conservative treatment of lumbar spinal stenosis--a review

The aim of this study is to provide an analysis of the literature and our own experience in the conservative treatment of lumbar spinal stenosis. Although lumbar spinal stenosis is treated mostly non-operatively there are only a few reports in the literature about the results of conservative treatment. All the recent articles about surgical procedures for LSS mention ineffective preoperative treatment without explaining it. So far there have been no randomised clinical trials to obtain evidence regarding the clinical outcome of non-surgical management. We provide an actual overview about the conservative treatment of LSS referring only to retrospective studies, guidelines and expert opinions. Solely the treatment of LSS with epidural steroids, which is recommended by most of the authors, has been evaluated by several randomised controlled studies with a high level of evidence. As far as we can summarise at present, a multidisciplinary conservative treatment programme is most effective not only for discogenic low-back pain but also for LSS with a concentration on physiotherapy, behavioural therapy, epidural injections and a special back training which is presented in this paper. Patients with LSS should receive a trial of the proposed conservative, aggressive treatment before surgery is considered.