To the Editor.
—We read with interest the discussion of spinal stenosis by Dr Garfin in Clinical Crossroads.1 Indeed, symptomatic spinal stenosis is an increasingly recognized clinical problem, particularly in elderly patients. Nonoperative treatment options are of considerable interest because, as noted by Garfin, successful long-term surgical outcomes are seen in only 70% and reoperation may be required in 10% to 20% of patients. Though the nonoperative literature is sparse and largely uncontrolled, additional nonsurgical therapeutic options not discussed in the article deserve mention.Exercise-oriented physical therapy based on the McKenzie approach has recently been studied in an open, short-term, uncontrolled trial of patients with symptomatic lumbar canal stenosis.2 At 12 weeks' follow-up, improvement in at least 1 outcome variable—pain score, Roland functional disability score, walking distance, or standing time—was noted in 58% of the patients. Thirty-three percent of the patients noted improvement in at least 2 variables.
Mazanec D, Drucker Y. A 50-Year-Old Woman With Spinal Stenosis. JAMA. 1996;275(18):1401. doi:10.1001/jama.1996.03530420028026