Surgery or Physiotherapy? Current Evidence for Lumbar Spinal Stenosis

In a narrative synthesis 22 studies were researched and compared the effectiveness of non-surgical and surgical treatments.

Key Findings:

Both conservative and surgical management improved:

• Pain

• Disability

• Walking capacity

• Functional outcomes

Non-Surgical Treatment

Evidence supports physiotherapy as an effective first-line treatment, especially for patients with mild-to-moderate symptoms.

Effective interventions included:

• Exercise therapy

• Manual therapy

• Structured physiotherapy programs

• Multimodal rehabilitation

• Acupuncture

The best outcomes were seen when treatment combined manual therapy, exercise, and walking training, rather than exercise alone. Conservative care also improved patient-reported function and walking tolerance.

What does this mean for physiotherapy?*

• Physiotherapy should remain the first-line treatment for patients with mild-to-moderate lumbar canal stenosis and no progressive neurological deficits.

• A multimodal approach: combining manual therapy, exercise, walking training, education, and functional rehabilitation.

• Physiotherapists play a key role in improving walking tolerance, reducing disability, and delaying or avoiding surgery in appropriately selected patients.

• If patients continue to experience persistent neurogenic claudication, severe functional limitations, or progressive neurological deficits despite high-quality conservative care, referral for surgical assessment is appropriate.

• After decompression surgery, postoperative rehabilitation remains essential to maximize functional recovery and improve long-term patient outcomes.

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Source: Patrekar S, Shinde S, Shinde A, Jagdale D, Shetty N. Comparative Clinical Outcomes of Non-surgical and Surgical Treatment Methods for Lumbar Canal Stenosis: A Systematic Review. Cureus. 2026 Jul 2;18(7):e111963. doi: 10.7759/cureus.111963.

*Disclaimer: This document contains a summary and interpretation of scientific material and does not constitute an official representation of the original publication. No guarantee is made regarding the accuracy, completeness, or interpretation of the information presented. All responsibility for verifying the content and drawing conclusions from the original source rests with the reader. I expressly disclaim any liability for errors, inaccuracies, omissions, or any direct or indirect consequences arising from the use or reliance on this document.