Optimizing Nonsurgical Interventions for Lumbar Spinal Stenosis in Older Adults: New NIH R01 Grant Exploring Efficacy of Manual Therapy and Exercise

Lumbar spinal stenosis (LSS) affects a significant portion of older adults. While many individuals with imaging evidence of LSS (e.g., MRI) remain asymptomatic, those who exhibit symptomatic disease can have profound changes in their mobility, functionality, and experience persistent pain.

LSS is characterized by the narrowing of the spinal canal, often leading to intermittent neurogenic claudication, manifesting as pain, numbness, loss of sensation, weakness, and other symptoms. The prevalence of LSS escalates with age, and it can play an outsized role in functional decline and reduced quality of life among older adults.

Debra K. Weiner, MD, professor of Medicine in the Division of Geriatric Medicine at the University of Pittsburgh School of Medicine was awarded a National Institutes of Health R01 grant for her project titled "Optimizing Impact of Manual Therapy and Exercise on Lumbar Spinal Stenosis with Neurogenic Claudication: A Multi-Site Feasibility Study."

The new grant continues decades of research and clinical trials Dr. Weiner has conducted on the nature of and efficacious treatments for chronic low back pain in older adults.

It builds upon findings from recent prospective research conducted by Dr. Weiner and colleagues who found more than half of older adult veterans (n=193) enrolled in her study who underwent decompressive laminectomy (DL) for lumber spinal stenosis failed to gain any appreciable benefit in function from the procedure. Given decompressive laminectomy is the most prevalent surgical recourse aimed at remediating LSS and its symptoms, coupled with Dr. Weiner’s findings and similar findings in other studies conducted in the general population of older adults, and given the majority of DLs are elective, the lens is now shifting towards nonsurgical interventions as the primary approach to achieve symptom relief and functional improvement.

New Grant Details

Recent trials show modest efficacy of manual therapy and exercise (MTE) in spinal stenosis patients exhibiting intermittent neurogenic claudication (INC). Building upon this foundation, Dr. Weiner’s study seeks to augment the efficacy of MTE by supplementing it with intramuscular electroacupuncture (IMEA) – an intervention showing promise in preliminary research.

Her study will be anchored at Boston Medical Center and the Orlando VA Medical Center. These sites were selected for their “sociodemographic diversity and a significant cohort with multiple comorbidities.”

The study will assess the feasibility of the chosen treatments, adherence levels among participants, and the quality of data collection.

Sixty participants diagnosed with LSS who haven’t undergone lumbar surgery will be recruited for this study. They will be divided into three groups:

• One group receiving manual therapy and exercises for three months.
• The second group receiving the same treatment with additional monthly sessions for a subsequent six months.
• The third group will be administered both manual therapy and intramuscular electroacupuncture for three months, followed by monthly sessions of the combined treatments for another six months.

Dr. Weiner’s study will monitor participants' symptom improvements and other vital parameters, including mobility, emotional well-being, medication usage, and general health indicators.

To ensure the integrity of the study, health care providers will undergo standardized training, and regular evaluations will be conducted. The researchers will also monitor attendance rates and adherence to home exercises.

Study Implications

Because the current paradigm of surgical palliation for DL so far yields suboptimal outcomes for many individuals, exploring other noninvasive therapeutic pathways, like MTE and IMEA, is imperative for uncovering potential therapeutic options that can alleviate the pain and mobility challenges plaguing LSS patients.

“Our study will give us a preliminary basis for whether any of our treatment protocols show promising efficacy that we can then further explore in a larger, randomized trial,” says Dr. Weiner. “With the sheer number of individuals getting surgery for LSS who do not experience meaningful or durable responses and adequate alleviation of symptoms, we have to find a new path forward for this patient population.”

More About Dr. Weiner

Dr. Weiner focuses her research on chronic pain. She serves as PI on a multisite study designed to improve the management of chronic low back pain in older adults that is supported by a VA Merit Review award. Learn more about Dr. Weiner’s work.