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Is surgery - spinal fusion - better than no surgery for spinal stenosis? Possibly, but if so, only marginally. A common cause of back pain in people over the age of 50, is degeneration of the vertebrae - the spinal bones - causing them to become misaligned. Because we're talking about wear and tear and arthritis here, it's not the sort of problem that spinal manipulation is much help for. What happens with this misalignment is that the canal which runs through the vertebrae and contains the spinal nerves, becomes narrowed. This spinal stenosis is associated with back and leg pain usually made worse by walking. The commonest operation for this is fusion where surgeons use screws or metal splints or both to stop the vertebrae moving over one another. Spinal fusion is controversial with past trials failing to show benefits. A recent study followed two groups of 300 people. One was given things like exercise and pain relief with surgery available if needed or wanted. The second group was offered spinal fusion but could choose not to have it. The results were hard to interpret because a large proportion of people crossed category. If analysed according to the original intention - which is the most reliable way to analyse such a study, there were no differences between the groups. But a relatively simple comparison between those treated and those not showed a benefit for the surgery but that give a distorted impression. The rate of surgical complications was about one in ten usually involving a tear of the spinal canal lining. An accompanying commentary suggested caution but that the study probably tipped the balance a little in favour of surgery.
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