Wheeling back to health: Wheeled walkers may relieve pain for Spinal Stenosis patients
Lumbar Spinal Stenosis (LSS), characterized by the narrowing of the spinal canal and a resulting array of maladies, is the most common cause for surgery in the country for those over 60 years of age, with as many as 400,000 Americans presently suffering from the condition. Due to the aging baby boomer generation, this number will continue to grow in coming years, making it a necessity that some initiative be taken to reduce the number of surgery room visits for LSS cases. In an attempt to prepare for this looming occurrence, a study was performed on a small group of 60+ers with LSS to determine if the use of wheeled walkers had an alleviating impact on pain and discomfort. The primary purpose of the trial was to significantly reduce the rate of surgery.
The concept for the study was based on the tendency many with LSS have to lean forward on shopping carts or similar objects to cope with pain. Common lower extremity symptoms associated with LSS include loss of sensation, paresthesia (pins and needles), difficulty standing or walking and nocturnal pain in the feet, legs and thighs. Despite its frequency, LSS remains enigmatic in both the causes of its coming about and preventative methods against it. For starters, axial loading, which occurs during walking, and any type of spinal extension both decrease the diameter of the spinal canal and may lead to many of the mentioned symptoms in an aging spine. Lumbosacral flexion--accomplished by leaning forward on something like a shopping cart--on the other hand, opens the spine and may reduce nerve compression and similar symptoms. The North American Spine Society (NASS) has released a set of recommendations that stress the utilization of conservative methods of treatment before considering surgery, which is both costly and potentially dangerous. Fortunately, most forms of conservative treatment such as therapy are effective after 2 to 4 months, but for those with severe cases, further attention is necessary.
Subjects were sought who experienced symptoms of LSS and were subjected to spinal imaging to either confirm or deny the presence of the condition. A total of 52 patients were diagnosed with LSS and subsequently instructed to use a 3- or 4-wheeled rollator walker at all times for a total of 14 weeks. Patients with nocturnal symptoms were further encouraged to sleep in the fetal position or with a pillow beneath their legs to continue lumbosacral flexion and keep the spine open. Patients were reevaluated after 3-5 days of the recommendations to report any changes in pain severity and walking ability. After another 10 days, they were assigned to gradually reduce the use of their walkers, if it was possible, to an amount that kept improvement at a constant. The two factors used to determine the walkers' effectiveness were walking distance, in which patients reported the amount of improvement in walking from baseline to the trial's completion (excellent =over 400% increase; poor =<99%), and neurogenic (nervous system-related) pain reduction, which had patients rate the reduction of pain and discomfort in their backs with a pain scale (excellent =75%-100%; poor =<24%).
Results had 30 out of the 52 subjects (58%) reporting improvements in ambulation as excellent, 7 (13%) as good, 8 (16%) as moderate and 7 (13%) as poor after 3-5 days. Of the 48 patients with neurogenic pain, relief was reported as excellent for 22 (46%), good for 11 (23%), moderate for 7 (14.5%) and poor for 8 (16.5%) after the same period. Though results from the studies completion were unavailable and the trial size is comparably small to others, the data still reflect the immediate alleviation that wheeled walkers can create. With such drastic improvements in the majority of test subjects, this trial should open the doors for physicians to further explore possible advantages of this type of initiative. Additional endeavors into the benefits of conservative treatments for LSS can help create safer solutions for the condition that don't require surgery and the negative baggage associated with it.
-As reported in the April '08 edition of The Journal of Family Practice
-By Greg Gargiulo
